Endocrine Abstracts

Introduction: Thyroid TB is rare even in endemic countries, and diagnosis is often delayed by atypical presentation and clinical latency. Rarely, if ever, does a tumor and infection form in the same thyroid nodule We report the case of a subject who was followed for a hot nodule and who was found to be both thyroid tuberculosis and tumor damage.

Observation: This is a 59 year old patient vaccinated against BCG, with no histrory of pulmonary or extrapulmonary tuberculosis, followed by atrial fibrillation on anticoagulant therapy. Treated for a few months for hyperthyroidism on a toxic hot nodule confirmed by radionuclide imaging. After laboratory euthyroidism was achieved with synthetic antithyroid medicinal products, the patient underwent a total thyroidectomy. The definitive pathological examination had noted epiteloid and gigantocellular follicles with the presence of caseous necrosis, concluding with thyroid tuberculosis; as well as the presence within the same nodule of an oncocyte tumor with a potential of uncertain malignancy. The clinical and paraclinical examination did not reveal any other site of tuberculosis, thus being a primary thyroid disease The patient was placed on anti-bacillary treatment for a period of 6 months

Discussion: The hot nodule, unlike the cold nodule, is generally a benign nodule with a low risk of malignant degeneration, this risk is far from being zero and approved by many authors but the coexistence within the latter of tuberculosis and a tumor is rare, even exceptional. Tuberculosis associated with a thyroid tumor is rare but can be common in immunocompromised patients. In the literature, several cases of a combination of tuberculosis and thyroid tumor have been reported. The causal relationship was demonstrated by a meta-analysis between pulmonary tuberculosis and lung cancer with a 74% risk of progressing to lung cancer after diagnosis of pulmonary tuberculosis. So far no studies have been performed that can demonstrate the same causal relationship for thyroid tuberculosis and neoplastic risk, although the relationship appears to be consistent.