Amyloid accumulation in the toxic nodule of the thyroid gland in a patient with end stage renal failure

Abstract

Amyloidosis is characterized by accumulation of amorphous, proteinaceous material in various organs and tissues of the body. Amyloid may accumulate in the thyroid gland in cases of medullary thyroid carcinoma and systemic amyloidosis. Amyloid accumulates extracellularly in the thyroid parenchyma and disrupts the normal follicular patterns. Most of the cases reported up to now were clinically euthyroid, but many presentation forms and overlaps have been reported. Herein we present a patient with toxic nodular goiter with amyloid deposition in the toxic nodule as well as the remaining thyroid tissue.

Figure 1

Thyroid scan reveals the active nodule of the left lobe and suppression in the remaining thyroid tissue.

Figure 2

The thyroid nodule is seen apparently seperated from the surrounding thyroid tissue. The nodule shows follicular patterns of different sizes not compressing the surrounding tissue. Eosinophilic and hyaleneceous amorphous substance accumulation is seen in the arterial wall and interstitium compatible with amyloid (H & E).

Figure 3

Pink-colored substance accumulation compatible with amyloidosis is seen in the arterial wall inside the nodule together with the parafollicular area and interstitium (crystal violet).

Figure 4

Red-colored amorphous substance accumulation compatible with amyloid is seen in the interstitium within the nodule together with the arterial wall compressing parafollicular cells and thyroid epithelial cells (congo red).

Figure 5

Material was confirmed apple green under polarized microscope.