Endocrine Abstracts

Introduction: Thyroid tuberculosis is a rare localization that can pose problems of differential diagnosis with thyroid nodules. Its rarity is explained by the good oxygenation of the thyroid parenchyma and the bacteriostatic role of thyroid hormones. The definitive diagnosis is based on the pathological examination of the surgical specimen or after cytopathology or bacteriological examination of the transparietal puncture in complicated cases of collection.

Observation: This is a 30-year-old patient with no notable history who presents with multiherenodular goiter with the presence of satellite lymphadenopathy confirmed by cervical ultrasound without associated general signs. The thyroid workup is normal. A total thyroidectomy is performed with simple operative consequences. Pathological examination revealed a hyperplastic thyroid parenchyma with the presence of epitheliogigantocellular granulomas with local caseous necrosis. Anti-tuberculosis treatment is started for six months as well as LT4 supplementation with a favorable clinical course and normal TSH.

Discussion and conclusion: Thyroid tuberculosis remains a rare condition. It poses a diagnostic problem and sometimes induces inappropriate treatment. Fine-needle aspiration makes it possible to make the diagnosis by looking for an epithelio-gigantocellular granuloma with caseous necrosis and/or a Koch’s bacillus and to initiate the anti-tuberculosis treatment which consists of multiple antibiotic therapy. Excisions are exceptional except in cases of diagnostic doubt as is the case for our patient. The prognosis is very favorable.