Int J Thyroidol.  2015 Nov;8(2):221-225. 10.11106/ijt.2015.8.2.221.

A Case of Amyloid Goiter Masquerading as Graves' Disease

• Kim HB
• Lee SH
• Ko KB
• Cho JH

• KMID: 2171237
• DOI: http://doi.org/10.11106/ijt.2015.8.2.221

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.

Keyword

Thyroid gland; Goiter; Amyloidosis; Graves' disease

MeSH Terms

Amyloid*
Amyloidosis
Diagnosis
Drug Therapy
Female
Goiter*
Graves Disease*
Hand Strength
Heart
Heart Failure
Humans
Hyperthyroidism
Kidney
Middle Aged
Multiple Myeloma
Plaque, Amyloid
Receptors, Thyrotropin
Surgical Instruments
Thyroid Gland
Thyroidectomy
Amyloid
Receptors, Thyrotropin

Figure

• 

  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.

• 

  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).

Reference

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