Endocrine Abstracts

Introduction: The incidence of extrapulmonary forms of tuberculosis has increased. Thyroid tuberculosis is an uncommon condition even in developing countries where tuberculosis is endemic. Herein we report an original case of a 62 year-old woman in whom tuberculosis was revealed by thyroid nodule.

Observation: Our patient is a 62-year-old woman with a history of mild asthma for 7 years. She presented with a slight neck swelling and a loss of weight and appetite for three months, with no discomfort on swallowing nor tenderness. There were no specific signs suggestive of dysthyroidism. She denied any history of tuberculosis, night sweats, fever, dyspnea or cough. On examination, she had a slight thyromegaly without tenderness nor bruit. Other systemic and regional examinations did not show any abnormality. The blood routine tests were normal. The thyroid function tests disclosed normal levels of serum thyroid stimulating hormone (TSH) and free thyroxin (FT4). Blood and urine calcium levels were normal. Cervical ultrasound revealed multiple nodules of various sizes in the right lobe associated to lymph nodes in the lower internal jugular chain. Ultrasound (US)-guided fine needle aspiration biopsy of lymphadenopathies demonstrated non-caseating granulomatous lymphadenitis. A CT scan was performed and revealed apical ground glass opacities, symmetric hilar, mediastinal and abdominal adenopathies. Quantiferon test was positive. Tuberculin skin test was positive too with an 18 mm-diameter reaction. Sputum smear microscopy was negative. Bronchoalveolar lavage was normal: there was no alveolitis, CD4/CD8 ratio was normal, mycobacterium tuberculosis PCR was negative. The angiotensin-converting enzyme and beta2-microglobulin were not elevated. The patient was diagnosed with ganglionar and thyroid tuberculosis. The patient is now put on anti-tuberculosis drugs: combination of Rifampicin, Isoniazid, Ethambutol and Pyrazinamide for 2 months, which will be followed by Rifampicin and Isoniazid for 4 months. Now the patient is remaining euthyroid, neck swelling is not progressing and her appetite improved significantly. Follow-up sonography is scheduled in one month.

Conclusion: Thyroid tuberculosis is a scarce condition which should be considered in front of thyroid nodule. Fine-needle aspiration cytology may avoid unnecessary surgical intervention. Treatment options for thyroid tuberculosis are antituberculous drugs and/or surgery.