Pneumocystis CariniiInfection of the Thyroid in a Hypothyroid Patient with AIDS: Diagnosis by Fine Needle Aspiration Biopsy*

Abstract

A 49-yr-old homosexual man with acquired immunodeficiency syndrome presented with a left-sided neck mass. He was found to have a firm goiter. He was clinically euthyroid, but had laboratory evidence of primary hypothyroidism. Radioactive iodine scan of the thyroid showed homogeneous uptake over an enlarged right lobe and absence of uptake over the left lobe. Two fine needle aspiration biopsies of the thyroid revealed the presence of Pneumocystis carinii (P. carinii) organisms on the Gomori's methenamine silver strain. After courses of iv and oral therapy with trimethoprim-sulfamethoxazole, a third fine needle aspiration biopsy failed to reveal any organisms. A repeated radioactive iodine scan of the thyroid showed return of uptake over the left lobe. Thyroid function tests normalized with levothyroxine, and the goiter decreased in size. To our knowledge, this is the first report of hypothyroidism associated with P. carinii infection of the thyroid. P. carinii infection should be considered in the differential diagnosis of human immunodeficiency virus infected individuals presenting with cold thyroid nodules. Fine needle aspiration biopsy is a valuable tool in assessing these patients.

Histopathological Changes of the Thyroid and Parathyroid Glands in HIV-Infected Patients

“…While in previous case reports, Pneumocystis jiroveci has been a prominent cause of thyroiditis in HIV patients [18–21], particularly in patients on aerosolized pentamidine [22, 23], we did not identify this microorganism in any of our patients. This may be due to the fact that many patients presented to our hospital with symptoms suggestive of Pneumocystis jiroveci pneumonia and were treated promptly with trimethoprim-sulfamethoxazole leading to absence of histological evidence of this microorganism at autopsy.…”

Thyroid function in human immunodeficiency virus patients treated with highly active antiretroviral therapy (HAART): a longitudinal study

“…Regarding the thyroid, some authors have reported in rare cases an involvement of the gland by opportunistic infections or tumours, such as Kaposi sarcoma, and are most often found at autopsy in advanced HIV disease without ante‐mortem clinical or biochemical signs of altered thyroid function, although overt hyper or hypothyroidism have occasionally been described 9–12 . Moreover, altered thyroid hormone levels have often been reported with clinical effects in patients with HIV‐related diseases treated with rifampicin 13 or with immunomodulatory agents 14–16 …”

Pneumocystis jiroveci thyroiditis: report of 15 cases in the literature

“…One patient also presented the involvement of the thyroid by Kaposi sarcoma 21 . Five patients had previous P. jiroveci pneumonia, 15,20–22 and two of them have had more than one episode of P. jiroveci 21,22 . Most patients (73%) were receiving inhalatory pentamidine prophylaxis 2,14–20,23 .…”