Primary tuberculosis of the thyroid gland: an unexpected cause of thyrotoxicosis

Abstract

We describe a 38-year-old Indian man who presented with a 2-week history of fever, night sweats and neck swelling who was found to be clinically thyrotoxic with a nodular goitre, tachycardia and high fever. Biochemical investigation revealed hyperthyroidism in association with deranged liver function tests and raised inflammatory markers. Ultrasound and CT scans of the neck revealed multinodular thyroid enlargement. He was considered most likely to have an acute infectious thyroiditis with a differential diagnosis of a toxic multinodular goitre and was started on carbimazole and antibiotics. He underwent fine needle aspiration of the thyroid which revealed necrotic cells and acid-fast bacilli, confirming a diagnosis of primary tuberculosis (TB) of the thyroid gland with no evidence of any other organ involvement on systemic imaging. He was started on TB therapy for 6 months and discharged with outpatient follow-up. Symptoms and biochemical markers subsequently resolved.

An interesting case of tuberculosis of the thyroid gland

“…Resolution is usually complete with medical treatment alone, although occasionally surgery or drainage are necessary adjuncts. 8…”

Acute thyroid swelling in renal transplant recipient

“…This diagnosis should always be considered in a patient with neck swelling especially among residents of endemic countries and in SOT recipients. [ 1 ]…”

“…Tuberculosis (TB) of the thyroid gland is rare even in areas where the prevalence of TB is very high. [ 1 ] There is no case report or case series of thyroid TB among solid organ transplant (SOT) recipients who otherwise have a very high risk of acquiring TB. The condition usually mimics more common thyroid conditions such as adenoma, carcinoma, lymphoma, or multinodular goiter.…”

Tuberculosis of the Thyroid—a Diagnostic Enigma

“…Hypothyroidism is caused by extensive glandular destruction by caseous necrosis. Thyroid tuberculosis is sometimes associated with thyrotoxicosis [6].…”