Journal of Clinical Endocrinology & Metabolism
, doi:10.1210/jc.2006-0786
The Journal of Clinical Endocrinology & Metabolism Vol. 91, No. 10 3711-3712
Copyright © 2006 by The Endocrine Society
Thyroid Lymphoma Arising from Hashimoto’s Thyroiditis
Barbra S. Miller and
Paul G. Gauger
Department of General Surgery, Division of Endocrine Surgery, University of Michigan Health System, Ann Arbor, Michigan 48109-0331
Address all correspondence to: Barbra S. Miller, 2920 Taubman Health Care Center, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0331. E-mail: barbram{at}umich.edu.
This 75-yr-old female patient with hypothyroidism and Hashimoto’s thyroiditis was noted 3 yr ago to have a small asymmetric goiter (left>right). Rapid growth of the thyroid (right>left) over 2–3 months caused dysphagia, shortness of breath, and paralysis of the right vocal fold. Thyroidectomy was attempted at an outside facility to relieve compressive symptoms, but endotracheal intubation was unsuccessful due to severe tracheal deviation and supraglottic narrowing. A computerized tomography (CT) scan of the neck (Fig. 1
) was subsequently obtained. The patient was referred to our institution for further anesthetic and surgical management. Due to the history of Hashimoto’s thyroiditis and a rapid increase in size of the thyroid gland, diagnoses of thyroid lymphoma and anaplastic thyroid cancer were considered. Fine-needle aspiration was insufficient for diagnosis, and an incisional biopsy confirmed the diagnosis of diffuse large B cell lymphoma. Staging revealed no additional lymphadenopathy. Chemotherapy using Rituxan-CHOP (cyclophosphamide, adriamycin, vincristine, prednisone) led to a dramatic response of the tumor and a complete resolution of compressive symptoms (Fig. 2).
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FIG. 1. CT of the neck showing extension of thyroid lymphoma into right and left lateral neck with mass effect, deviation of the trachea, encasement of the right carotid artery, and occlusion of the right internal jugular vein.
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FIG. 2. Postchemotherapy CT reveals a dramatic response to treatment and return of the trachea to midline.
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Thyroid lymphoma is quite rare; however, the incidence is higher in patients with a history of Hashimoto’s thyroiditis (1, 2). A relatively rapid growth in size of the thyroid gland should lead one to consider lymphoma of the thyroid or anaplastic thyroid cancer as a diagnosis. Diagnosis can be made with fine-needle aspiration or core needle biopsy; however, larger amounts of tissue (obtained by performing an incisional biopsy) may be required for flow cytometry and confirmation of diagnosis (3, 4). Chemotherapy and radiation are the mainstays of treatment. Palliative thyroidectomy is occasionally required (5).
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Footnotes
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Disclosure summary: The authors have nothing to disclose.
First Published Online June 13, 2006
Abbreviation: CT, Computerized tomography.
Received April 11, 2006.
Accepted June 6, 2006.
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References
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- Ha CS, Shadle KM, Medeiros LJ, Wilder RB, Hess MA, Cabanillas F, Cox JD 2001 Localized non-Hodgkin lymphoma involving the thyroid gland. Cancer 91:629–635[CrossRef][Medline]
- Pyke CM, Grant CS, Habermann TM, Kurtin PJ, van Heerden JA, Bergstralh EJ, Kunselman A, Hay ID 1992 Non-Hodgkin’s lymphoma of the thyroid: is more than biopsy necessary? World J Surg 16:604–610[CrossRef][Medline]
- Derringer G, Thompson LDR, Frommelt RA, Bijwaard KE, Heffess CS, Abbondanzo SL 2000 Malignant lymphoma of the thyroid gland: a clinicopathologic study of 108 cases. Am J Surg Pathol 24:623–639[CrossRef][Medline]
- Sippel RS, Gauger PG, Angelos P, Thompson NW, Mack E, Chen H 2002 Palliative thyroidectomy for malignant lymphoma of the thyroid. Ann Surg Oncol 9:907–911[Medline]
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