Limits...
Tuberculosis of the thyroid gland: two case reports.

Baidya A, Singha A, Bhattacharjee R, Dalal BS - Oxf Med Case Reports (2015)

Bottom Line: The other patient had a solitary thyroid nodule with normal thyroid function.Involvement of other organs was absent in both cases.Proper diagnosis may avoid unnecessary surgical interventions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Endocrinology and Metabolism , Institute of Postgraduate Medical Education and Research/SSKM Hospital , Kolkata, West Bengal , India.

ABSTRACT
Tuberculosis of the thyroid gland is a rare entity even in countries like India where tuberculosis is endemic. The patients may present with thyroid swelling, inflammation and very rarely thyroid dysfunction. Caseous necrosis and epithelioid cell granulomas on fine-needle aspiration cytology and histopathological examination are diagnostic. We present two cases of thyroid gland tuberculosis. One patient had subclinical thyrotoxicosis with presentation mimicking acute bacterial thyroiditis. The other patient had a solitary thyroid nodule with normal thyroid function. Involvement of other organs was absent in both cases. Proper diagnosis may avoid unnecessary surgical interventions.

No MeSH data available.


Related in: MedlinePlus

Leishman Giemsa stain showing caseous necrosis (×4).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4664839&req=5

OMV028F3: Leishman Giemsa stain showing caseous necrosis (×4).

Mentions: A 48-year-old male presented to the outpatient clinic with neck swelling in the last 2 weeks. He had mild discomfort on swallowing and slight tenderness. There was no specific history suggestive of hypo- or hyperthyroidism. He did not have sore throat, cough or sputum production. Though the patient denied any history of fever, he complained of night sweats and loss of appetite. The patient did not have any past history of tuberculosis. On examination, he had a diffuse, mildly tender thyromegaly (Grade 2) and a red nodule located in the thyroid isthmus (Fig. 1). A lymph node (2 × 2 cm) was also palpated in the anterior cervical region. His pulse and blood pressure were 92/min and 136/76 mmHg, respectively. Other systemic and regional examinations did not show any abnormality. Considering the clinical profile, a provisional diagnosis of acute bacterial thyroiditis was made and the patient was put on empirical antibiotic (Co-amoxiclav). Subsequently, investigations showed FT4—1.60 ng/dl (0.80–1.90), TSH—0.019 µIU/ml (0.40–4.00), anti-TPO antibody—20 IU/ml (0–45) and ESR—35 mm/first hour. Chest X-ray was normal, but Mantoux test was positive (18 × 15 mm). USG of the thyroid gland revealed multiple cysts of various sizes in both lobes with the largest measuring 3.0 × 1.8 cm in the isthmus (Fig. 2). FNAC showed extensive caseous necrosis without demonstrable acid fast bacillus (AFB; Fig. 3). The patient was put on anti-tuberculosis drugs and subsequently, culture of aspirated fluid for Mycobacterium tuberculosis came out positive. The patient was put on WHO Category-1 anti-tubercular regime, i.e. combination of Rifampicin (450 mg), Isoniazid (300 mg), Ethambutol (1200 mg) and Pyrazinamide (1500 mg) thrice-a-week for 2 months followed by Rifampicin and Isoniazid for 4 months. His appetite and sense of wellbeing improved significantly within 6 weeks of starting treatment. The thyroid became non-tender on palpation. Biochemical examination at 6 weeks showed TSH of 3.5 µIU/ml and FT4 of 1.1 ng/dl. The patient remained euthyroid till last follow-up visit (18 months after completion of treatment). There was no palpable nodule at that time. Follow-up USG showed resolution of the cystic lesions.Figure 1:


Tuberculosis of the thyroid gland: two case reports.

Baidya A, Singha A, Bhattacharjee R, Dalal BS - Oxf Med Case Reports (2015)

Leishman Giemsa stain showing caseous necrosis (×4).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664839&req=5

OMV028F3: Leishman Giemsa stain showing caseous necrosis (×4).
Mentions: A 48-year-old male presented to the outpatient clinic with neck swelling in the last 2 weeks. He had mild discomfort on swallowing and slight tenderness. There was no specific history suggestive of hypo- or hyperthyroidism. He did not have sore throat, cough or sputum production. Though the patient denied any history of fever, he complained of night sweats and loss of appetite. The patient did not have any past history of tuberculosis. On examination, he had a diffuse, mildly tender thyromegaly (Grade 2) and a red nodule located in the thyroid isthmus (Fig. 1). A lymph node (2 × 2 cm) was also palpated in the anterior cervical region. His pulse and blood pressure were 92/min and 136/76 mmHg, respectively. Other systemic and regional examinations did not show any abnormality. Considering the clinical profile, a provisional diagnosis of acute bacterial thyroiditis was made and the patient was put on empirical antibiotic (Co-amoxiclav). Subsequently, investigations showed FT4—1.60 ng/dl (0.80–1.90), TSH—0.019 µIU/ml (0.40–4.00), anti-TPO antibody—20 IU/ml (0–45) and ESR—35 mm/first hour. Chest X-ray was normal, but Mantoux test was positive (18 × 15 mm). USG of the thyroid gland revealed multiple cysts of various sizes in both lobes with the largest measuring 3.0 × 1.8 cm in the isthmus (Fig. 2). FNAC showed extensive caseous necrosis without demonstrable acid fast bacillus (AFB; Fig. 3). The patient was put on anti-tuberculosis drugs and subsequently, culture of aspirated fluid for Mycobacterium tuberculosis came out positive. The patient was put on WHO Category-1 anti-tubercular regime, i.e. combination of Rifampicin (450 mg), Isoniazid (300 mg), Ethambutol (1200 mg) and Pyrazinamide (1500 mg) thrice-a-week for 2 months followed by Rifampicin and Isoniazid for 4 months. His appetite and sense of wellbeing improved significantly within 6 weeks of starting treatment. The thyroid became non-tender on palpation. Biochemical examination at 6 weeks showed TSH of 3.5 µIU/ml and FT4 of 1.1 ng/dl. The patient remained euthyroid till last follow-up visit (18 months after completion of treatment). There was no palpable nodule at that time. Follow-up USG showed resolution of the cystic lesions.Figure 1:

Bottom Line: The other patient had a solitary thyroid nodule with normal thyroid function.Involvement of other organs was absent in both cases.Proper diagnosis may avoid unnecessary surgical interventions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Endocrinology and Metabolism , Institute of Postgraduate Medical Education and Research/SSKM Hospital , Kolkata, West Bengal , India.

ABSTRACT
Tuberculosis of the thyroid gland is a rare entity even in countries like India where tuberculosis is endemic. The patients may present with thyroid swelling, inflammation and very rarely thyroid dysfunction. Caseous necrosis and epithelioid cell granulomas on fine-needle aspiration cytology and histopathological examination are diagnostic. We present two cases of thyroid gland tuberculosis. One patient had subclinical thyrotoxicosis with presentation mimicking acute bacterial thyroiditis. The other patient had a solitary thyroid nodule with normal thyroid function. Involvement of other organs was absent in both cases. Proper diagnosis may avoid unnecessary surgical interventions.

No MeSH data available.


Related in: MedlinePlus