ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P359 | DOI: 10.1530/endoabs.63.P359

A rare cause of goiter

María Belén Ojeda Schuldt, Carmen Bautista Recio & Mariana Tomé Fernandez-Ladreda

Hospital Punta de Europa, Algeciras, Spain.

Introduction: Amyloidosis is a rare systemic disease of unknown etiology characterized by the extracellular deposition of proteinaceous (amyloid) material in different organs of the body. About 40-50% are of secondary cause (Amyloidosis AA) Amyloid goiter is a rare condition, usually associated with the secondary form.

Case: We reported a 41-year-old male with a history of non-steroidal anti-inflammatories, high blood pressure and smoking habit. Maintains follow-up in nephrology for stage V chronic kidney failure secondary to AA amyloidosis and receives hemodialysis periodically. In one of his reviews, a goiter was found by chest CT scan, which is why is referred to endocrinology unit, where an increase in the thyroid gland was confirmed by cervical ultrasound at the expense of both lobes (Third grade) and showed besides, a heterogeneous echoestructure with hyperechoic predominance, with patchy hypoechoic areas, diffusely, without associated adenopathies. The thyroid profile was within normal range, with negative antithyroid antibodies. The scintigraphy showed a generalized hypocaptation compatible with thyroiditis in resolution or hypothyroid goiter, but could not rule out a thyroid block by drugs or iodinated contrasts. Two needle aspiration with fine needle were performed with non-diagnostic results. Cervical nuclear magnetic resonance showed a marked decrease in thyroid tissue attenuation, similar to fat, and a large goiter that compresses the trachea and enters the retrosternal region. The patient reported an associated cervical compressive clinic, so finally it is decided to surgically intervene through thyroidectomy. The anatomopathological results confirm amyloid goiter.

Conclusions: Only a small percentage of amyloidosis produces a symptomatic goiter. The thyroid function of these patients may be normal, although they are frequently hypothyroid and rarely hyperthyroid. Clinically, it is usually presented as a non-painful mass in cervical region, and in isolated cases can produce local symptoms by compression of neighboring structures. The treatment, in the absence of compressive symptoms, should be limited to the control of thyroid function and associated diseases, and carry out total removal of the gland when symptoms appear. The definitive diagnosis will be given by the anatomopathological study of the surgical piece

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