Endocrine Abstracts

Premise: multinodular goiter and compressive symptoms in the neck could not be necessarily associated.

Case-report: A 82-year-old woman diagnosed follicular lymphoma in 2017 reached to the Emergency Department in Agoust 2021 because of a progressive and worsening dysphagia and dysphonia, begun six weeks before. The patient complained a weight loss of about 8 kg due to the inability in feeding. Her medical history was relevant for thyroid goiter, known since the age of 18, undergone partial right lobectomy at the age of 30 and regular follow-up until July 2021 (also FNA with a benign response was performed in 2019). Thyroid function tests showed subclinical hyperthyroidism. Anti-Tg, anti-TPO and TSH-Receptor antibodies resulted negative. ENT consultation and laryngoscopy showed a paralysis of the left vocal. Neck ultrasound and CT were performed, confirming the presence of a substernal goiter with the whole left thyroid lobe filled-up by a multilobate nodule about 3.5 cm-sized, strongly adherent to the trachea and the internal jugular vein. No enlarged cervical lymphnodes were described. Total body CT identified a solid mass 3 cm-sized in the mediastinum at the level of D3, with no evident cleavage plane to oesophagus. Enlarged mediastinal lymphnodes and pulmonary localization were found, suspicious for metastatic localizations. Cerebral MRI described a solid tissue area 1 cm-sized in the left jugular foramen, surrounding IX, X, XI cranial nerves in the intra-foramina tract, suspicious for perineural metastatic disease. Core-biopsy of the left thyroid nodule and of the paravertebral mass was performed identifying a diffuse and aggressive B-cell lymphoma\. Bone marrow aspiration resulted negative. The patient died a few weeks after in consequence of an acute gastrointestinal bleeding.

Discussion: Secondary thyroid lymphoma can be diagnosed in presence of thyroid nodules with cytologic benign result. Metastatic thyroid tumors are very uncommon and occur as goiter, worsening dysphonia and stridor, dysphagia, tightness of the neck. It is clinically important to discriminate between primary and secondary thyroid lymphoma because therapy and prognosis are different: thyroid metastatic lymphoma has a worse prognosis than primary thyroid lymphoma and it requires an accurate clinical and radiological staging because most of the cases have a widely disseminated disease from the diagnosis and a poor prognosis.