Primary tuberculosis of the thyroid gland

Abstract

Thyroid tuberculosis is a rare disease even in countries in which tuberculosis (TB) constitutes an endemic disorder. The diagnosis is often difficult as the clinical presentation has no distinct characteristics. We report a 47-year-old woman who presented with a painful nodular swelling of the neck, confirmed by physical examination and sweating. Ultrasonography disclosed nodules of the pyramidal lobe with cystic change, and bilateral multiple hypoechogenic lymph nodes along the jugular and carotid chains. Thyroid function tests were in the normal range, there were no signs of inflammation and the tuberculin test was negative. There was no evidence of tuberculosis in any other organ. The patient had surgery in which the pyramidal lobe was removed. Microscopic examination of the thyroid parenchyma and the excised lymph node revealed necrotizing epithelioid granulomas with Langhans' giant cells. The diagnosis of thyroid tuberculosis was therefore made. The patient was put on isoniazid, rifampicin, ethambutol and pyrazinamid for the subsequent 2 months and was subsequently given isoniazid and rifampicin for the subsequent 6 months with a favourable outcome. Although seldom observed, tuberculosis should be kept in mind in the differential diagnosis of nodular lesions of the thyroid.

Primary thyroid gland tuberculosis: a conundrum in a child

“…10 TB primarily affecting the thyroid gland is much more uncommon and, predictably, more difficult to diagnose. 11 Nevertheless, various pathological varieties of thyroid gland lesions in tuberculous inflammation have been described, which includes the miliary spread to the thyroid gland as a part of generalized dissemination, enlargement of the thyroid gland due to caseating granulomas developing in adenomatous type of thyroid, cold abscess formation, sometimes associated with multiple sinuses, chronic fibrosing TB and acute abscess formation. 6,12 On further exploring the existing literature on thyroid gland TB, certain clinicopathological features of this condition draw special attention, which in turn can help in its correct diagnosis and treatment.…”

Tubercular thyroid abscess: A case report

“…Focal spread may be primary of thyroid gland called primary tuberculosis of thyroid gland [10]. However, it may be secondary from adjacent lymph node [11].…”

Primary tuberculosis of thyroid

“…Role of surgery in TB thyroid remains to drain any TB abscess and remove affected thyroid lobe/s. 2 Specimen however is not usually sent for bacterial and AFB culture due to low suspicion of TB, unless a frank abscess develops. Granulomatous inflammation of thyroid can occur in TB, sarcoidosis, granulomatous thyroiditis, fungal infections or foreign body reactions.…”

“…Since these patients usually present with a diffuse or localized thyroid swelling, a differential of thyroid TB takes a backseat in favor of other common entities like multinodular goitre, neoplasia, thyroglossal cyst or lymphoma. 2 Many of these remain asymptomatic and thus Fine Needle Aspiration Cytology (FNAC) or histopathological examination of the resected specimen forms the mainstay of diagnosis. 3,4 Case Description -A 54 years old lady presented with complaint of painless progressive swelling in the region of thyroid since the past 6months.…”