Endocrine Abstracts

Introduction: Amyloid goiter (AG) may be associated with either primary amyloidosis (deposit of amyloid protein AL) or secondary amyloidosis (deposit of amyloid protein AL) in chronic inflammatory diseases including tuberculosis, cystic fibrosis, ulcerative colitis, ankylosing spondylitis and familial Mediterranean fever. To our knowledge, this is the first case of AG concomitant with PTC in a patient with HIV infection.

Case presentation: 67-year-old male immigrant from Somalia with past medical history of HIV with CD4 count of 427/ml complained of painful progressive enlargement of neck mass for three months with dysphagia, dyspnea on exertion associated with weight loss and generalized weakness. A diffuse non-tender asymmetrically enlarged goiter was palpated with no cervical lymphadenopathy. Ultrasonography revealed diffusely echogenic heterogeneous significantly enlarged thyroid gland without discrete cystic or definable mass. Right lobe measured 96×38×58mm, left lobe 76×38×42mm, and Isthmus 20mm. Free T4: 0.93 ng/dl (0.80–1.80ng/dl), TSH: 0.067 munit/ml(0.40–5.00), TSI:151%(0–139). CT showed asymmetric enlargement of the right thyroid lobe and isthmus with deviation of the trachea and esophagus without retrosternal extension or significant cervical lymphadenopathy. FNA showed deposition of AA Amyloid localized in thyroid gland with positive Congo red staining. Surgical pathology revealed the same in addition to a small focus of 0.3 cm PTC. Further evaluation confirmed that patient’s amyloidosis is localized only to thyroid without systemic involvement.

Discussion: Endocrinopathy is well recognized in relation to HIV infection itself or as a side effect from HAART. However, the association of HIV infection with AG is not well established. The patient presented in this case has AG localized amyloid deposition in thyroid gland without systemic amyloidosis and no clear chronic inflammatory condition other than HIV infection. Another unique feature is the presence of PTC as apposed to what has been described of AG being mostly associated with medullary carcinoma. There is no specific treatment for AA amyloidosis but treating primary underlying condition can halt the progression. Due to compressive symptoms, surgery was offered in this case.

Conclusion: AG should be included as differential diagnosis of rapid enlargement of thyroid gland in HIV patients.