Abstract
Objective: To present a clinical case of primary thyroid tuberculosis associated with hypothyroidism. Case details: Primary thyroid tuberculosis with associated hypothyroidism is an unusual manifestation of tuberculous infection. We present the case of a 31-year-old female patient who reported a loss of appetite, hair loss, and the development of cervical nodules without fever or secretions. Her thyroid ultrasound revealed only an atypical cervical lymph node on the right side, with no other abnormalities. Laboratory tests indicated hypothyroidism, and she was started on levo
Objective: To present a clinical case of primary thyroid tuberculosis associated with hypothyroidism. Case details: Primary thyroid tuberculosis with associated hypothyroidism is an unusual manifestation of tuberculous infection. We present the case of a 31-year-old female patient who reported a loss of appetite, hair loss, and the development of cervical nodules without fever or secretions. Her thyroid ultrasound revealed only an atypical cervical lymph node on the right side, with no other abnormalities. Laboratory tests indicated hypothyroidism, and she was started on levothyroxine sodium 25 mcg/day. Despite the treatment, the patient remained symptomatic. Fine-needle aspiration cytology of the thyroid suggested a hyperplastic follicular nodule or papillary cancer, leading to a decision for total thyroidectomy. Anatomopathological examination of the thyroidectomy specimen revealed chronic granulomatous thyroiditis with necrosis and granulomatous lymphadenitis. Given the strong response to the tuberculin test, a six-month course of antitubercular treatment was initiated. Final considerations: This case punctuates the importance of considering thyroid tuberculosis in the differential diagnosis of cervical masses and the necessity of biopsy and histopathological examination to accurately diagnose the disease and initiate timely treatment.
Objective: To present a clinical case of primary thyroid tuberculosis associated with hypothyroidism. Case details: Primary thyroid tuberculosis with associated hypothyroidism is an unusual manifestation of tuberculous infection. We present the case of a 31-year-old female patient who reported a loss of appetite, hair loss, and the development of cervical nodules without fever or secretions. Her thyroid ultrasound revealed only an atypical cervical lymph node on the right side, with no other abnormalities. Laboratory tests indicated hypothyroidism, and she was started on levothyroxine sodium 25 mcg/day. Despite the treatment, the patient remained symptomatic. Fine-needle aspiration cytology of the thyroid suggested a hyperplastic follicular nodule or papillary cancer, leading to a decision for total thyroidectomy. Anatomopathological examination of the thyroidectomy specimen revealed chronic granulomatous thyroiditis with necrosis and granulomatous lymphadenitis. Given the strong response to the tuberculin test, a six-month course of antitubercular treatment was initiated. Final considerations: This case punctuates the importance of considering thyroid tuberculosis in the differential diagnosis of cervical masses and the necessity of biopsy and histopathological examination to accurately diagnose the disease and initiate timely treatment.
References
AKBULUT S, et al. Thyroid tuberculosis in southeastern Turkey: is this the resurgence of a stubborn disease. World Journal of Surgery, 2011; 35(8): 1847-1852.
BANSAL LK, et al. Thyroid tuberculosis. Indian Journal of Tuberculosis, 2021; 68(2): 272-278.
BRASIL. Ministério da Saúde. 2024. In: Tuberculose. Disponível em: https ://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z/t/tuberculose. Acessado em: 31 julho. 2024.
BULBULOGLU E, et al. Tuberculosis of the thyroid gland: review of the literature. World Journal of Surgery, 2006; 30(2): 149-155.
CATAÑO JC e ROBLEDO J. Tuberculous lymphadenitis and parotitis. In: Tuberculosis and Nontuberculous Mycobacterial Infections,2017; 343-354.
CHAUDHARY P, et al. Diagnostic and Management Guidelines of Thyroid Tuberculosis: Our Experience and Systematic Review. Indian Journal of Otolaryngology and Head and Neck Surgery, 2023; 75(2): 1302-1310.
GHOSH A, et al. Primary tuberculosis of thyroid gland: a rare case report. American Journal of Otolaryngology, 2007; 28(4): 267-270.
GOLDEN MP e VIKRAM HR. Extrapulmonary tuberculosis: an overview. American Family Physician, 2005; 72(9): 1761-1768.
KALSCHEUER R, et al. The Mycobacterium tuberculosis capsule: a cell structure with key implications in pathogenesis. Biochemical Journal, 2019; 476(14): 1995-2016.
KATARIA SP, et al. Primary tuberculosis of the thyroid gland: a case report. Asian Pacific Journal of Tropical Biomedicine, 2012; 2(10): 839-840.
LEBERT H. Die Krankheiten der Schilddrüse und ihre Behandlung. Breslau, 1862; 264.
LUIZ HV, et al. Thyroid tuberculosis with abnormal thyroid function-case report and review of the literature. Endocrine Practice, 2013; 19(2): 44-49.
MAJID U e ISLAM N. Thyroid tuberculosis: a case series and a review of the literature. Journal of Thyroid Research, 2011; 2011(1): 359864.
NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES. 2012. In: Clinical and research information on Drug-induced Liver Injury. Disponível em: https ://www.ncbi.nlm.nih.gov/books/NBK548763/. Acessado em: 31 jul. 2024.
ROLO M, et al. Epidemiology and factors associated with extra-pulmonary tuberculosis in a low-prevalence area. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 2023; 32: 100377.
SHAW JA, et al. Pleural tuberculosis: a concise clinical review. The Clinical Respiratory Journal, 2018; 12(5): 1779-1786.
SMITH I. Mycobacterium tuberculosis pathogenesis and molecular determinants of virulence. Clinical Microbiology Reviews, 2003; 16(3): 463-496.
TAN KK. Tuberculosis of the thyroid gland--a review. Annals of the Academy of Medicine, Singapore, 1993; 22(4): 580-582.
VARGHESE A, et al. Primary tuberculosis of thyroid. American Journal of Otolaryngology, 2015; 36(6): 808-809.
WHO. WORLD HEALTH ORGANIZATION. 2023. In: Tuberculosis. Disponível em: https ://www.who.int/news-room/fact-sheets/detail/tuberculosis. Acessado em: 31 jul. 2024.
