Surgical considerations about amyloid goiter

Villanueva, Augusto; Villanueva, María Jesús García; Villanueva, Mercedes; Blanco, Roberto Rojo; Guirao, María Vicenta Collado; Montero, José María; Pérez, Rafael Beni; Montes, Irene Moreno

doi:10.1016/j.endoen.2013.06.001

Cited by 4 publications

(5 citation statements)

References 16 publications

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“…Systemic AA amyloidosis, previously called as secondary amyloidosis, is characterized by the infiltration of apo serum amyloid A which is released by the liver as an acute phase reactant. It is a rare type of amyloid deposition which usually coexists with chronic inflammatory diseases like familial Mediterranean fever, inflammatory bowel disease, bronchiectasis, rheumatoid arthritis, ankylosing spondylitis, chronic osteomyelitis, Sjogren's syndrome, tuberculosis [2] , [6] . These patients usually present with long standing and severe manifestations of such chronic inflammatory conditions ultimately leading to end organ failure.…”

Section: Discussionmentioning

confidence: 99%

“…Virchow coined the term “amyloid” in 1854 to represent deposits which have sugars that cause starch-like staining [1] , [2] . Amyloidosis is the extracellular deposition of fibrillary amyloid proteins in various organs; most commonly the kidney, resulting in possible structural and functional loss of the organ.…”

Section: Introductionmentioning

confidence: 99%

“…Amyloidosis is the extracellular deposition of fibrillary amyloid proteins in various organs; most commonly the kidney, resulting in possible structural and functional loss of the organ. It is caused due to abnormal protein folding [2] .…”

Section: Introductionmentioning

confidence: 99%

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Rare cause of thyroid enlargement: Localized AA amyloid goiter – A case report

Chincholi

Ahmed

Kumar

et al. 2022

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rare cause of thyroid enlargement: Localized AA amyloid goiter – A case report

Chincholi

Ahmed

Kumar

et al. 2022

International Journal of Surgery Case Reports

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“…Amyloid deposits can be seen in the thyroid commonly in systemic amyloidosis, estimated between 20 and 50% in AL amyloidosis and up to 80% in AA amyloidosis [ 5 ]. On the other hand, a goiter from a large quantity of amyloid deposition known as amyloid goiter is very rare.…”

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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“…References in literature on AG are limited. Until 2000, García-Villanueva et al referred 200-250 published cases [5]. In our review, we have only found 9 cases published in the last 10 years, all of them were associated with kidney disease (CKD), with or without kidney transplant: 3 of them were associated with familial Mediterranean fever [1,6], 2 cases were associated with rheumatoid arthritis [3,7], 1 case was associated with bronchiectasis [2], another case with bronchiectasis and ankylosing spondylitis [1], and other 2 cases were associated with Crohn's disease [4] and multiple myeloma [8] ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

An Unusual Amyloid Goiter in a 48-Year-Old Woman with Rheumatoid Arthritis, Secondary Amyloidosis and Renal Failure

López-Muñoz

Bermúdez

Marín-Jiménez

et al. 2019

Case Reports in Endocrinology

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Amyloid goiter (AG) is characterized by the presence of deposits of amyloid protein in the thyroid tissue in sufficient amounts to produce enlargement of the gland, accompanied by fat deposition or thyrolipomatosis. It can be seen in long-standing inflammatory disorders, with the common characteristic of amyloidotic renal failure. In daily practice, practitioners should pay attention to the differential diagnosis in patients with suggestive co-morbidities for amyloidosis. The clinic is a progressive increase of the thyroid gland with compressive symptomatology (dyspnea, dysphagia, and changes in the voice). The main imaging finding is diffuse fatty infiltration of the thyroid. The amyloid goitre was most probably in the general context of amyloidosis, regardless of the other complications. We present a case of a 48-years-old female with amyloid goiter secondary to rheumatoid arthritis and renal failure.

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Surgical considerations about amyloid goiter

Cited by 4 publications

References 16 publications

Rare cause of thyroid enlargement: Localized AA amyloid goiter – A case report

Rare cause of thyroid enlargement: Localized AA amyloid goiter – A case report

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

An Unusual Amyloid Goiter in a 48-Year-Old Woman with Rheumatoid Arthritis, Secondary Amyloidosis and Renal Failure

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