Introduction: Lymphoma of the thyroid gland is an uncommon condition occurring primarily in older women. Most patients have a short history of enlarging thyroid or a neck mass causing tracheal compression. There is also a strong association between thyroid lymphoma and Hashimotos thyroiditis. The diagnosis is established by biopsy. The conventional approach to treatment is combination of radiation therapy with multi-agent chemotherapy, while there is no significant role for extirpative surgery in the management of thyroid lymphoma. Prognosis of localised tumours (stage IE, Ann Arbor classification) is excellent. Extrathyroidal involvement (stage IIE-IVE) reduces the 5-year survival rate to about 70%, provided that current therapy regimens are respected. In this clinical case, the different stages from Hashimotos thyroiditis and thyroid lymphoma are demonstrated by histology. We describe a rare case of Hashimotos thyroiditis in a woman with chronic lymphoid leukemia.
Case report: A 65-year-old woman suffering from goiter and hypothyroidism for 9 years, treated with levothyroxine 125 mcg, followed in our Centre in May 2018. The blood tests revealed that she had euthyroidism (TSH 2.3 mU/l). In blood test there was lymphocytic leukemia, found early about 6 months ago. Ultrasound confirmed Hashimotos thyroiditis and an enlarged thyroid with no nodules. The CT scan additionally revealed multiple paratracheal ganglia, intrathoracic extension and tracheal compression. Cytology was compatible with chronic lymphocytic thyroiditis (Bethesda II). In our case Hashimotos thyroiditis was diagnosed with chronic lymphocytic leukemia, and surgical treatment was recommended. Definitive treatment was made by performing total thyroidectomy. And histological examination confirmed the diagnosis of chronic lymphocytic thyroiditis.
Conclusions: It is important to choose correct way and treatment in differential diagnostic between chronic lymphocytic thyroiditis and chronic lymphoid leukemia.
18 May 2019 - 21 May 2019