Painless thyroiditis associated with severe inflammatory reactions in amyloid goiter: a case report

A case of amyloid goiter associated with intrathyroid parathyroid and lymphoepithelial cyst

Diffuse enlargement of the thyroid gland accompanied by an interstitial tissue deposition of amyloid is a special entity termed an amyloid goiter. An amyloid goiter is a rare thyroid lesion, which has been described a long time ago. In this report, we add a new classic case of amyloid goiter that differs from other reported cases in its association with intrathyroid parathyroid and lymphoepthelial cyst involved with amyloidosis. The presence of parathyroid tissue inside the thyroid parenchyma and surrounded by amyloid material elicited a diagnostic problem due to suspected medullary carcinoma. Careful histological examination and immunohistochemical staining for parathormone and calcitonin have largely helped in the differential diagnosis. Bilaterality, diffuse, and homogeneous involvement of the thyroid gland, with absence of definite masses, all direct the diagnosis toward amyloid goiter.

Thyroid uptake of 67Ga-citrate is associated with thyroid autoimmunity and hypothyroidism in patients with sarcoidosis

PURPOSE

To evaluate the association of gallium-67 ((67)Ga)-citrate thyroid uptake with the presence of thyroid disorders in patients with sarcoidosis (S patients).

METHODS

Eighty-four S patients were evaluated by a complete thyroid work-up (neck ultrasound, circulating thyroid hormones and anti-thyroid antibodies, fine-needle aspiration).

RESULTS

In S patients with (67)Ga thyroid uptake (respect those without): serum thyroid-stimulating hormone, the titre of anti-thyroid peroxidase (AbTPO) and/or anti-thyroglobulin antibodies (AbTg), and the prevalence of S patients with hypothyroidism or with positive AbTg or AbTPO was significantly higher; a thyroid hypoechoic pattern was more frequent. The prevalence of thyroid nodules was not significantly different between the two groups. Two cases of papillary thyroid cancer were observed in S patients without (67)Ga thyroid uptake, whilst no case in those with (67)Ga thyroid uptake.

CONCLUSIONS

(67)Ga thyroid uptake is associated with the presence of aggressive autoimmune thyroiditis and hypothyroidism in S patients; thyroid function and ultrasonography should be performed in the presence of (67)Ga thyroid uptake.

Amyloid goiter as a manifestation of primary systemic amyloidosis

Primary amyloidosis involving the thyroid gland is rare and limited to case reports. We report the case of a previously healthy 47-year-old female presenting with a 1-month history of nausea, vomiting, and diffuse thyroid enlargement. Over the next 3 months, she simultaneously developed renal insufficiency dysphagia and hoarseness of voice. Biopsies from the gastric antrum, duodenum, bone marrow, and kidney were positive for vascular deposition of amyloid. Ultrasound of the thyroid revealed diffuse enlargement of the thyroid gland, which was 32.8 ML in volume, with diffuse hyperechogenicity. Fine needle aspiration (FNA) biopsy was positive for amyloid by Congo red staining, and cytology was negative for malignancy. The patient was treated with dexamethasone 40 mg daily on days 1-4, 9-12, and 17-20 for 3 months. On 3-month follow-up, the patient's nausea and vomiting had resolved and renal insufficiency improved. Ultrasound of the thyroid demonstrated decrease in the size of the goiter to 23.2 ML. Amyloid goiter is seen only in approximately 0.04% of patients with primary systemic amyloidosis. No data is currently available regarding treatment of primary amyloidosis and its effect on the goiter. However, we have evidence demonstrating that successful treatment of amyloidosis decreases thyroid enlargement and improves organ dysfunction.