甲状腺疾患と治療のジャーナル
オープンアクセス

概要

Diagnostic Challenge of Rapid Enlargement of the Thyroid: Autoimmuneb Thyroiditis - Thyroid Lymphoma - Malignant Thyroid Disease

Gudrun Leidig-Bruckner, Karin Frank-Raue, Angela Lorenz, Thomas J. Musholt, Arno Schad and Friedhelm Raue

clinical outcome in patients with rapidly growing thyroid. Design: Case series, three patients presenting with a growing enlarged thyroid at a secondary practice for endocrinology. Methods / Outcome measures: Diagnostic findings, clinical course and comparison to the literature. Results: All patients were postmenopausal women (age: 58-74 years). The leading symptom was goiter with growing volume or mass in the neck region. Upon ultrasound, all patients demonstrated hypoechoic irregular areas suggesting autoimmune thyroiditis. In one patient, the thyroid capsule could not be distinguished suggesting infiltrative disease, while another patient had markedly enlarged cervical lymph nodules. Thyroid function was hypothyroid in two patients and euthyroid in one. The latter patient had elevated anti-thyroid antibody titres, fine needle aspiration cytology indicated lymphoma and diagnosis was confirmed by excisional biopsy. This patient was successfully treated with chemotherapy remaining disease free four years later. In the two other patients, repeated cytology and lymph nodule resection could not provide definite diagnosis and both underwent thyroidectomy. Final histology revealed large B-cell lymphoma localized within the thyroid in one patient, who is disease free two years after surgery and diagnosis of chronic autoimmune thyroiditis with severe lymphadenitis in the other. Conclusions: Thyroid lymphoma should be considered in patients with increasing thyroid volume and signs of autoimmune thyroiditis. Finite differential diagnosis between autoimmune thyroiditis and lymphoma cannot always be achieved cytologically. Sufficient material is necessary and some patients may need thyroidectomy to classify disease definitively.