Amyloid goiter: difficulties of differential diagnosis, choice of treatment tactics

Abstract

Amyloid goiter is an orphan disease characterized by the deposition of amyloid proteins in the thyroid parenchyma, which can be the result of both localized primary deposition and secondary, against the background of persistent chronic inflammatory disease. The diagnosis is made through imaging techniques and histological examination of thyroid tissue. Depending on the degree of enlargement of the thyroid gland, the presence of hypothyroidism, as well as compression syndrome, therapeutic tactics are reduced to dynamic observation, the achievement of an euthyroid state, and in case of a pronounced cosmetic defect and / or tracheal compression, surgical intervention. Histochemical staining of the resected drug is necessary to make a definitive diagnosis. The prognosis is generally favorable, but it depends on the underlying cause of amyloid deposition and the degree of thyroid damage. In this clinical case, we describe a 36-year-old patient with periodic disease, AA-amyloidosis with predominant kidney damage, after kidney allotransplantation due to a history of end-stage chronic kidney disease. The patient contacted the center with complaints of difficulty breathing, swallowing, during examination, the thyroid gland is enlarged in size, according to ultrasound data, specific changes in the thyroid gland indicate the amyloid genesis of goiter. According to the hormonal examination, it is euthyroidism. According to the cytological examination of a thyroid biopsy: extracellular deposits of a dense structureless substance colored red-brown, most corresponding to the deposition of amyloid, were found in smears of liquid cytology when stained with congo red.