Endocrine Abstracts

Introduction: Amyloidosis results from deposition of insoluble proteins in the extracellular space. It can be both primary or secondary to chronic inflammatory diseases. Although microscopic thyroid involvement is common, cases in which it becomes clinically evident (amyloid goiter) are rare.

Case report: Woman, 45 years. In 2009, she was diagnosed with Crohn’s disease after Bartholin’s gland abscess excision and evaluation for weight loss, anemia and renal failure. In 2010, during hospitalization in Gastroenterology department, an euthyroid diffuse goiter was identified (without compressive symptoms, except easy choking) and she was oriented to endocrinology consultation. Due to chronic kidney disease, she underwent renal biopsy (Jan/2011), that established the diagnosis of renal amyloidosis. Because she presented hepatic cytolysis a liver biopsy was also done, which revealed amyloid deposits in the wall of some portal arteries. She has been followed in Endocrinology since 05/2011, being asymptomatic, with diffuse goiter. Thyroid function tests and calcitonin are normal with negative thyroid antibodies. Thyroid ultrasound has shown an enlarged gland (LD 16×25×58 mm, LE 18×20×57 mm T×AP×L), with increased echogenicity and diffuse heterogeneity, but without dimensional progression. Considering the imaging findings and the presence of systemic amyloidosis, she underwent thyroid core biopsy, which confirmed the amyloid goiter diagnosis.

Discussion: In the majority of cases of amyloid goiter there is a rapid thyroid growth (in weeks to months), although in the case described there was no progression. Despite the widespread involvement of the thyroid by the disease, patients are usually euthyroid. Since amyloid deposits can also be found in association with medullary thyroid carcinoma, this possibility must always be excluded. In conclusion, the diagnosis of amyloid goiter should be considered in patients with systemic amyloidosis or chronic inflammatory disease who present with bilateral and rapidly progressive enlargement of the thyroid, even in the presence of normal thyroid function.