Amyloid Goiter: A Case Report and Review of the Literature

Abstract

Amyloid goiter is a very rare manifestation of amyloidosis. Here, we describe the case of a 40-year-old male, who presented with upper airway obstructive symptoms including hoarseness and breathing difficulty, to highlight the clinical and pathological features of secondary amyloidosis of the thyroid gland and the difficulties in making a preoperative diagnosis. The patient had previously been wounded in the war in Bosnia, which resulted in the right kidney being surgically removed. Further, he had undergone two surgical interventions on both hips due to osteomyelitis and was on a chronic dialysis program due to a progressively poor left kidney function that had eventually resulted in complete loss of renal function. Thyroid function tests were normal, and the patient clinically was euthyroid; biochemical investigations were within normal limits. Results from sonography, computed tomography scan of the neck, scintigraphy and fine-needle aspiration cytology were nondiagnostic. Therefore, a thyroid biopsy was carried out, and amyloid deposits were found. After preoperative work-up, total thyroidectomy was performed with no complications. We conclude that amyloid goiter may have no major impact on thyroid function even when a substantial amount of amyloid has replaced the normal thyroid parenchyma, as was the case in our patient. Amyloid goiter should be suspected in all patients with a progressive, rapidly growing bilateral thyroid enlargement with concomitant inflammatory processes or in patients undergoing hemodialysis treatment.

Keywords: Amyloid goiter; secondary amyloidosis; thyroid enlargement; thyroidectomy.

Figure 1

Diffusely enlarged thyroid gland

Figure 2

Thyroid scintigraphy

Figure 3

Macroscopic view of thyroidectomy specimen

Figure 4

Hematoxylin–eosin ×10: Fat tissue with rare, slightly dilated follicles filled with colloid and lined with atrophic epithelium and amorphous eosinophilic material in the interstitium

Figure 5

Hematoxylin–eosin ×20: Homogenous, amorphous, eosinophilic substance and some follicles at the right side

Figure 6

Congo red ×10: Orangeophilic homogeneous substance in the interfollicular area