Case Report: A Rare Association of Diffuse Thyroid Lipomatosis with Amyloid Deposition

Cavaco, Daniela; Rafael, Ana Alves; Cabrera, Rafael; Vilar, Helena; Leite, Valeriano

doi:10.1159/000518444

Cited by 4 publications

(16 citation statements)

References 10 publications

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“…Coca-Pelaz et al [ 9 ] and Nessim et al [ 10 ] reported a papillary thyroid carcinoma within an amyloid goiter due to primary amyloidosis. As in our case, most patients with amyloid goiter present with an enlarged thyroid gland, usually bilateral and diffuse, which can rapidly progress over weeks to months [ 3 , 4 , 9 ] and it can be associated with compressive symptoms such as dysphagia, dysphonia, and dyspnea [ 4 , 9 , 10 ]. Thyroid function is usually normal [ 3 , 4 , 7 , 9 , 10 ], but a minority of patients have hyper- or hypo-thyroidism [ 14 ].…”

Section: Discussionmentioning

confidence: 78%

“…As in our case, most patients with amyloid goiter present with an enlarged thyroid gland, usually bilateral and diffuse, which can rapidly progress over weeks to months [3,4,9] and it can be associated with compressive symptoms such as dysphagia, dysphonia, and dyspnea [4,9,10]. Thyroid function is usually normal [3,4,7,9,10], but a minority of patients have hyper-or hypo-thyroidism [14]. As previously stated, our patient had normal levels of T4, T3, and TSH.…”

Section: Discussionmentioning

confidence: 81%

“…Imaging findings can vary according to the amount of amyloid. Hyperechogenicity in the US and low density on CT, as in our case, may be found in the presence of infiltration of fat tissue [ 3 , 4 ]. Diagnosis of amyloid goiter requires histologic analysis of the excised gland.…”

Section: Discussionmentioning

confidence: 99%

“…It may be caused by primary amyloidosis, associated with plasma cell dyscrasias, or, more frequently, by secondary amyloidosis, usually triggered by an inflammatory disease such as tuberculosis, bronchiectasis, familial Mediterranean fever, cystic fibrosis, ulcerative colitis, Crohn's disease, or rheumatoid arthritis, among others [2]. Amyloid goiter has been reported to be associated with diffuse thyroid lipomatosis [3,4], a rare condition characterized by infiltration of mature adipose tissue in the thyroid stroma without evidence of encapsulation [5]. Papillary thyroid carcinoma is the most common thyroid malignancy [6] and rare case reports have mentioned its occurrence associated with amyloid goiter [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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A 54-Year-Old Woman with Papillary Thyroid Carcinoma Associated with Secondary Amyloid Goiter and Thyroid Lipomatosis

et al. 2022

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Objective:Rare disease Background:Amyloid deposition in the thyroid gland can be primary or secondary and can result in goiter. There have been previous reports of amyloid goiter and thyroid lipomatosis or fatty infiltration. Papillary thyroid carcinoma is the most common thyroid malignancy. We report a rare case of a 54-year-old woman with papillary thyroid carcinoma associated with secondary amyloid goiter and thyroid lipomatosis. Case Report:A 54-year-old woman with chronic pyelonephritis and bronchiectasis presented with compressive symptoms due to an enlarged thyroid gland. Thyroid function test results were in the normal range and serum thyroid autoantibodies and serum calcitonin levels were undetectable. Cervical ultrasound showed a diffusely swollen thyroid and a well-defined nodule in the right lobe, of which fine-needle aspiration cytology was suspicious for follicular neoplasm. Computed tomography showed an enlarged thyroid with low attenuation, suggestive of diffuse lipomatosis of the gland. Total thyroidectomy was performed, and a histopathology study indicated the presence of papillary carcinoma and diffuse lipomatosis of the thyroid gland with amyloid deposition. The patient was later diagnosed with secondary amyloidosis. Conclusions:The presentation of secondary amyloidosis as a diffuse goiter with extensive fatty infiltration must be considered in the differential diagnosis of thyroid enlargement, especially those with rapid onset, and particularly in patients with a history of chronic inflammatory disorders or chronic infections predisposing to amyloid deposition. Rarely, differentiated thyroid carcinoma is found within an amyloid goiter and it must be excluded in the differential diagnosis.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A 54-Year-Old Woman with Papillary Thyroid Carcinoma Associated with Secondary Amyloid Goiter and Thyroid Lipomatosis

et al. 2022

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“…Amyloid goiter is described as an accumulation of amyloid, an amorphous proteinaceous material, in the thyroid gland in sufficient amounts to cause an increase in the size denotes amyloid goiter [ 1 ]. In occasional cases, the accumulation of fat coexists with the deposition of amyloid [ 2 ]. Although amyloid deposition in the thyroid is relatively common, a clinically significant enlargement due to its accumulation is rare.…”

Section: Introductionmentioning

confidence: 99%

Co-occurrence of Amyloid Goiter and Adipose Metaplasia in a Patient With History of Pulmonary Tuberculosis: A Case Report

Khan¹,

Ahmad²,

Williams³

et al. 2023

Cureus

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Amyloid goiter is described as an accumulation of amyloid, an amorphous proteinaceous material, in the thyroid gland. The deposition of amyloid is relatively common in the thyroid gland. However, a significant clinical enlargement due to amyloid accumulation and fat deposition in the thyroid stroma resulting in diffuse goiter leading to compressive symptoms is a rare phenomenon. In this report, we describe a rare case of amyloid goiter with adipose metaplasia in a 38-year-old woman with a history of pulmonary tuberculosis who presented to the outpatient department with complaints of heartburn, abdominal discomfort, and hoarseness of voice. Incidentally patient had diffused multinodular neck swelling. Preliminary blood investigations were normal. The contrast-enhanced computed tomography neck showed multiple non-enhancing lesions and a diffusely enlarged thyroid gland, causing a mass effect on the oropharynx posteriorly and minimally on the trachea. Fine needle aspiration cytology thyroid revealed thyroiditis. The patient underwent a total thyroidectomy, and histopathological examination of the specimen showed an extracellular eosinophilic amorphous substance that was positive for Congo red and showed apple-green birefringence under polarized light, and large areas of adipose metaplasia were noted, and a diagnosis was made. The amyloid involvement can result from localized primary deposition or secondary to chronic inflammatory disease. The prevalence of amyloid goiter in developed countries is due to primary amyloidosis, and in developing countries is due to secondary amyloidosis. Patients with a history of pulmonary tuberculosis commonly present with renal amyloidosis as its complication. Patients with an enlarged thyroid gland and a history of chronic inflammatory conditions or plasma cell dyscrasias should be evaluated with extreme suspicion. The correlation of tuberculosis with the subsequent development of amyloid goiter highlights the need for research in this area.

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A Case of Diffuse Thyroid Lipomatosis With Amyloid Deposits Presenting With Thyrotoxicosis

Gonzalez-Gil,

Ruiz-Santillan,

Force

et al. 2024

JCEM Case Reports

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Diffuse thyroid lipomatosis (DTL) is a rare entity of unknown etiology that can be associated with amyloidosis and rarely, thyrotoxicosis. Here, we present a case of DTL with amyloid deposits and concurrent thyrotoxicosis. A 64-year-old South-Asian woman with a several-year history of an enlarging goiter, unintentional weight loss, and work-up 10 months prior suggestive of thyroiditis presented with a viral syndrome in setting of several weeks of progressive fatigue. Her examination was notable for resting sinus tachycardia and massive painless goiter. Initial work-up revealed nephrotic range proteinuria with hypoalbuminemia, which progressed to end-stage-renal disease, elevated inflammatory markers, and elevated free thyroxine (FT4) with a suppressed thyrotropin. Hemodialysis was initiated. Further testing revealed a negative antithyroid antibody panel, an enlarged fatty thyroid per thyroid ultrasound and neck computed tomography, and normal 24-hour uptake on radioactive iodine uptake scan. Both renal and thyroid core biopsies showed amyloid deposits, with the latter confirming benign adipose tissue with entrapped thyroid follicles. Given her rising FT4 levels and persistent tachycardia, methimazole and atenolol were initiated. FT4 levels nearly normalized after uptitration of methimazole and dosing after dialysis. Although the etiopathogenesis and natural history of DTL remain unclear, we discuss the possible mechanisms of thyrotoxicosis in our patient.

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Case Report: A Rare Association of Diffuse Thyroid Lipomatosis with Amyloid Deposition

Cited by 4 publications

References 10 publications

A 54-Year-Old Woman with Papillary Thyroid Carcinoma Associated with Secondary Amyloid Goiter and Thyroid Lipomatosis

A 54-Year-Old Woman with Papillary Thyroid Carcinoma Associated with Secondary Amyloid Goiter and Thyroid Lipomatosis

Co-occurrence of Amyloid Goiter and Adipose Metaplasia in a Patient With History of Pulmonary Tuberculosis: A Case Report

A Case of Diffuse Thyroid Lipomatosis With Amyloid Deposits Presenting With Thyrotoxicosis

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