Amyloid Goiter: Clinicopathological Assessment of Two Cases and Review of Literature

Mohammed, Rabab Ahmed Ahmed; Yassin, Etemad H.; Radwan, Moustafa E.M.; Ahmed, Badawy M.; Ettouny, Lobna F.; Abozied, Alaa M.

doi:10.4236/ojpathology.2015.51004

Cited by 2 publications

(2 citation statements)

References 27 publications

(26 reference statements)

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“…Amyloid goitre is defined as the presence of amyloid protein in the thyroid in sufficient amounts to produce enlargement of the gland. It is a rare condition, and is occasionally associated with the presence of variable amounts of adipose tissue within the gland 6 . Patients typically present with a diffusely enlarged, non-tender goitre, which may enlarge rapidly with or without impingement on the airway.…”

Section: Discussionmentioning

confidence: 99%

Diffuse lipomatosis of the thyroid with amyloid deposition

Jacques

Stearns

2013

J. Laryngol. Otol.

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To our best knowledge, this patient represents the first reported case of diffuse lipomatosis of the thyroid gland causing goitre in a patient with AA amyloidosis. The presence of amyloid protein within the thyroid was not sufficient to cause enlargement per se, and was therefore of unclear significance. Together with previous reports of the concurrent deposition of amyloid and fat, this case raises questions as to the relationship between these two phenomena.

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Section: Discussionmentioning

confidence: 99%

Diffuse lipomatosis of the thyroid with amyloid deposition

Jacques

Stearns

2013

J. Laryngol. Otol.

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“…Generally, patients with amyloid goiter are euthyroid but some case reports described association with hypothyroidism or hyperthyroidism [ 14 , 15 ]. For example, Mohammed et al described a case of primary localized amyloidosis in the thyroid and hypothyroidism [ 16 , 17 ].…”

Section: Discussion /Conclusionmentioning

confidence: 99%

Evaluation of multinodular goiter and primary hyperparathyroidism leads to a diagnosis of AL amyloidosis

et al. 2022

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Background Amyloid goiter, defined as excess amyloid within the thyroid gland in such quantities that it produces a clinically apparent goiter, is a very rare manifestation of systemic amyloidosis with cases commonly seen in the setting of Amyloid A (AA) amyloidosis. Amyloid goiter as the primary clinical manifestation secondary to Amyloid light chain (AL) amyloidosis is very rare. We present a case of AL amyloidosis with initial manifestation as goiter with amyloid deposition in the thyroid and the parathyroid gland. Case Presentation A 73 year old male presented with goiter and compressive symptoms of dysphagia and hoarseness. Laboratory workup revealed normal thyroid function, nephrotic range proteinuria, elevated serum calcium level with an elevated parathyroid hormone level (PTH) consistent with primary hyperparathyroidism. Thyroid ultrasound showed an asymmetric goiter with three dominant nodules. Cervical computed tomography revealed a goiter with substernal extension and deviation of the trachea. Fine needle aspiration was unsatisfactory. There was also evidence of osteoporosis and hypercalciuria with negative Sestamibi scan for parathyroid adenoma. The patient underwent a total thyroidectomy and one gland parathyroidectomy. Pathology revealed benign thyroid parenchyma with diffuse amyloid deposition in the thyroid and parathyroid gland that stained apple green birefringence under polarized light on Congo Red stain. Immunochemical staining detected AL amyloid deposition of the lambda type. Bone marrow biopsy revealed an excess monoclonal lambda light chain of plasma cells consistent with a diagnosis of AL amyloidosis secondary to multiple myeloma affecting the kidney, thyroid, parathyroid gland, and heart. He was treated with 4 cycles of chemotherapy with a decrease in the M spike and light chains with a plan to pursue a bone marrow transplant. Conclusion Amyloid goiter as the primary clinical manifestation secondary to AL amyloidosis with deposition in the thyroid and parathyroid gland is rare. The top differential for amyloid deposits in the thyroid includes systemic amyloidosis or medullary thyroid carcinoma. The definitive diagnosis lies in the histopathology of the thyroid tissue. To diagnose systemic amyloidosis as the etiology for a goiter, a solid understanding of the causes of systemic amyloidosis coupled with a thorough evaluation of the patient’s history and laboratory data is necessary.

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Amyloid Goiter: Clinicopathological Assessment of Two Cases and Review of Literature

Cited by 2 publications

References 27 publications

Diffuse lipomatosis of the thyroid with amyloid deposition

Diffuse lipomatosis of the thyroid with amyloid deposition

Evaluation of multinodular goiter and primary hyperparathyroidism leads to a diagnosis of AL amyloidosis

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