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Endocrine Abstracts (2019) 67 O4 | DOI: 10.1530/endoabs.67.O4

Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA.

Background: Preexisting chronic autoimmune thyroiditis is the only known risk factor for thyroid lymphomas, a rare variant of thyroid cancer. Here, we describe a male patient with previously undiagnosed Hashimoto’s thyroiditis who presented with severe airway compromise due to a thyroid lymphoma.

Case report: 60 y/o, former smoker, presented with 2 month neck fullness and dyspnea that awakened him throughout the night due to malpositioning of his neck. He had no other symptoms. A neck and head CT demonstrated a thyroid goiter, with each thyroid lobe measuring 11.0 cm×4.0 cm with mass effect on the airway, hypopharynx, and esophagus. The patient was emergently intubated for airway protection. Thyroid studies were significant for subclinical hypothyroidism (TSH of 9.7 uIU/ml and fT4 of 0.85 ng/dl) with positive anti-tPO antibodies (2030 uIU/ml) consistent with Hashimotos thyroiditis. Thyroid ultrasound showed diffuse heterogeneous texture and biopsy showed plasmacytoid cells and lymphoplasmacytic infiltrate involving fibrous tissue. Flow cytometry confirmed a B- cell lymphoma with plasmacytic differentiation. The patient was started on chemoradiation.

Conclusions: Severe airway compromise may occur in up to 25% of patients with thyroid lymphoma. Given the dramatic clinical presentation of rapid growth and airway compromise, the clinical impulse is to treat surgically with a total thyroidectomy. However, the differential diagnosis of a rapidly growing goiter includes lymphoma, which can be quickly diagnosed with a core biopsy and flow cytometry. Such lymphomas respond quickly to the combination of chemotherapy (with steroid component) and local radiation, potentially obviating the need for tracheotomy.

Volume 67

7th ESE Young Endocrinologists and Scientists (EYES) Meeting

European Society of Endocrinology 

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