Amyloid Goiter Associated with Amyloidosis Secondary to Rheumatoid Arthritis

Abstract

Amyloidosis refers to a variety of conditions in which amyloid proteins are abnormally deposited in organs and/or tissues. The most common forms of systemic amyloidosis are primary amyloidosis (PA) of light chains and secondary amyloidosis (SA) caused by chronic inflammatory diseases such as rheumatoid arthritis (RA). Although involvement of the thyroid gland by amyloid is a relatively common phenomenon, clinically significant enlargement of the thyroid owing to amyloid deposition is a rare occurrence. In SA, the deposition of amyloid associated (AA) protein is associated with atrophy of thyroid follicles. The clinical picture of these patients is characterized by rapid, painless thyroid gland enlargement which may be associated with dysphagia, dyspnea, or hoarseness. Thyroid function is not impaired in most cases. Although amyloid goitre secondary to systemic amyloidosis due to chronic inflammatory diseases is relatively common, specifically related to RA is much more uncommon one and it is reported less in the literature. In this report, A 52-old-year female patient with amyloid goiter associated with amyloidosis secondary to rheumatoid arthritis is presented.

Thyroid lipomatosis in a 36-year-old patient with rheumatoid arthritis and a kidney transplant

“…Two other reports describe amyloid goiters with diffuse infiltration by adipose tissue (14, 15). The authors attribute the increase in size to amyloid deposits – in spite of the infiltration by fat – which underscores the lack of clear criteria to differentiate thyroid lipomatosis with amyloid deposits from amyloid goiters with fat infiltration.…”

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

“…Some of the published cases have reported massively enlarged thyroids with masses of 500-700 g [7]. e usual treatment is total thyroidectomy [3], performed in our case and in the 9 cases mentioned, necessary both to relieve symptoms and to establish the definitive diagnosis. Preoperatory suspicion is important if there are long-standing co-morbidities, including confirmed amyloidiosis, because it is useful to guide the surgeon, due to the risk of local extension and differential diagnosis with a thyroid carcinoma.…”

“…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). Hijazi et al [9] reviewed four more cases of thyrolipomatosis until 2018, publishing a new case in a 53-year-old woman with renal failure secondary to diabetic nephropathy, without anatomopathological study for amyloid.…”

“…Amyloid goiter (AG) is characterized by the presence of deposits of amyloid protein in the thyroid tissue, accompanied by a di use accumulation of adipose tissue, capable of producing a signi cant enlargement of the gland [1]. Although the normal thyroid gland may have adipocytes in peri and subcapsular areas and near the vessels, and, sometimes, focal microscopic deposition of amyloid might be seen in both primary and secondary amyloidosis, amyloid goiter is a very rare entity with only a few cases described in the literature [1][2][3]. e main nding of this entity is the di use in ltration of fat from the thyroid gland, which is also known as thyroid lipomatosis or thyrolipomatosis (TL), a confusion factor in the terminology of this pathology.…”

Gastrointestinal and Hepatic Disease in Rheumatoid Arthritis

“…62–66 Amyloidosis may cause dysmotility, and has been associated with goiter leading to extrinsic esophageal compression. 67–69…”