Journal List > Int J Thyroidol > v.8(2) > 1082729

Int J Thyroidol. 2015 Nov;8(2):221-225. Korean.
Published online November 30, 2015.  https://doi.org/10.11106/ijt.2015.8.2.221
Copyright © 2015. the Korean Thyroid Association. All rights reserved.
A Case of Amyloid Goiter Masquerading as Graves' Disease
Hyun-Bum Kim, Soo-Hyung Lee, Ki-Bum Ko and Jung-Hae Cho
Department of Otolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Correspondence: Jung-Hae Cho, MD, PhD, Department of Otolaryngology - Head & Neck Surgery, St. Vincent Hospital, The Catholic University of Korea, 93-6 Ji-dong, Paldal-gu, Suwon 16247, Korea. Tel: 82-31-249-8306, Fax: 82-31-253-3752, Email: jhchomd@catholic.ac.kr
Received June 29, 2015; Revised October 05, 2015; Accepted October 21, 2015.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Amyloidosis is an abnormal extracellular deposit of amyloid in various organs of the body. Amyloid goiter, defined by a clinically detectable thyroid enlargement due to amyloid deposition, is a rare cause of hyperthyroidism. We report the case of amyloid goiter mimicking Graves' disease in a 62-year-old woman. Graves' disease was diagnosed by diffuse goiter, hyperthyroidism, and positive TSH receptor antibody. Total thyroidectomy was planned due to progression of Graves' disease and respiratory distress. At surgery thyroid gland was very friable and fragmented like cobblestones when grasped with forceps. A diagnosis of amyloid goiter was established by the presence of diffuse amyloid deposits in the parafollicular areas. After systemic evaluation for amyloidosis, coexisting both multiple myeloma and systemic amyloidosis involving kidney and heart were detected. She underwent palliative chemotherapy but disease progressed. Amyloid goiter might be suspected in patient with thyroid enlargement and concomitant systemic disease such as renal or heart failure.

Keywords: Thyroid gland; Goiter; Amyloidosis; Graves' disease

Figures


Fig. 1
Preoperative imaging studies. (A) Ultrasonographic image showing enlarged thyroid gland (arrow) with heterogeneous echogenicity. (B) A thyroid scan (Tc-99m scintigraphy) showing diffusely enlarged thyroid gland with inhomogeneously decreased uptake in both thyroid lobes. (C) Non-enhanced axial CT scan showing symmetrically diffuse goiter without nodules.
Click for larger image


Fig. 2
Thyroid pathology. (A) The thyroid gland was soft and fragile. Most of remnant thyroid gland tissue was removed by suction during operation. (B) Eosinophilic and amorphous substance accumulation (arrows) is seen in the interstitium (H&E, ×200). (C) Congo red staining marks the deposit (arrows) (Congo red, ×200). (D) Amyloid deposition showing apple-green birefringence under polarized light microscope (×200).
Click for larger image

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