Endocrine Abstracts

Introduction: Graves’ disease GD is an autoimmune disease, which can manifest with a variety of extrathyroidal clinical syndromes. Though quite rare, this disease can also manifest with lymphoid hyperplasia.

Case report: Two cases are reported in the department of endocrinology and diabetology of Hedi Chaker hospital in Sfax-Tunisia from 2006 to 2016 associated GD with lymphoid hyperplasia reaction. The first case was a 32 years old male with history of GD 6 years back treated with propylthiouracil and beta blockers. He was admitted with follow complaints: dyspnea and edema of the lower limbs. The diagnosis of cardiothyrosis with dilated cardiomyopathy has been confirmed by echocardiography. Neck-chest computerized tomography (CT) has been made to explore swallowing disorder wich showed the presence of no compressed heterogeneous goiter with mediastinal polyadenopathy and bilateral suspect lung nodules. The body scan revealed the same results with other deep localization of lymph nodes. The infectious and inflammatory etiological investigations were negatives. A total thyroidectomy with biopsy of mediastinal lymph node under mediastoscopy confirmed histologically the presence of lymphocytic thyroiditis with a lymphoid hyperplasia. The second case was a 47 years postmenopausal female followed for Graves’s disease complicated with cardiothyreosis. We have discovered incidentally deep lymph nodes (mediastinal, coeliomesenteric, aortocave) with lung nodules. The biopsy of the lung was not conclusive. The stability of these lesions for 10 years argues for a reactive lymphoid hyperplasia.

Conclusion: Reactive lymphocyte proliferation remains a histological diagnosis. It is necessary to complete with exhaustive etiology investigation in front of this clinical presentation.