Amyloid Goiter in a Patient with Rheumatoid Arthritis and End-Stage Renal Disease

Abstract

The association between amyloidosis and collagen vascular diseases, such as rheumatoid arthritis (RA) is well-documented. Amyloid goiter is an extremely rare pathologic condition caused by a massive amyloid infiltration of the thyroid tissue. Our patient had been diagnosed with RA 20 years ago and was on hemodialysis for 7 years. He was assessed for decreased appetite, dysphagia, and nausea during the hemodialysis. On physical examination, the thyroid was diffusely enlarged with multiple nodules. He was biochemically euthyroid. Ultrasound of the thyroid gland showed multinodular goiter. A total thyroidectomy was performed. Histopathological examination showed dilated follicles surrounded by abundant homogeneous substance that stained positive with Congo red. The patient was reported as amyloid goiter. Complaints of the patient improved after the surgery. In the literature, amyloid goiter with RA in a hemodialysis patient is very rare. Amyloid goiter should be considered if there is a rapid thyromegaly causing pressure symptoms in the background of any disease with chronic inflammation.

Keywords: Amyloid goiter; hemodialysis patient; rheumatoid arthritis.

Figure 1

Accumulation of common extracellular and acellular homogeneous eosinophilic amorphous proteinaceous material (amyloid) between follicles in thyroid parenchyma with occasional mature fat deposits (arrows). Enlarged and elongated colloid-containing thyroid follicles with squamous metaplasia. (Hematoxylin Eosin 40X)

Figure 2

Thyroid follicles and blood vessels are surrounded by the accumulation of amyloid deposits, which are metachromatic-stained with Crystal Violet (arrows) (Crystal Violet 40X)