A rare case of thyroid tuberculosis

Abstract

Thyroid tuberculosis although known to be a rare entity provides a diagnostic challenge to the clinician. Clinically, radiologically and even histologically proving to be difficult to arrive at a diagnosis. Its incidence according to literature is 0.1-0.4%. Tuberculosis may be found at multiple sites but incidence in the thyroid, pancreas, striated and cardiac muscle is extremely rare. Herein, we discuss a case of a 60 year old female complaining of a swelling in the front of the neck (more on the right side) since 45 days. Clinically it appeared to be a thyroid swelling. An ultrasound showed a bulky right lobe with heterogeneous echoes. FNAC showed features suggestive of a follicular adenoma. Intraoperatively a firm thyroid was palpable and total thyroidectomy was done. Histopathological examination was done revealing langhan giant cells and an area of caseous necrosis, confirming tuberculosis. The patient was started on thyroid replacement therapy and anti-tubercular therapy. The patient had no significant complications in the 6 months follow up period. In tuberculosis endemic areas, one must maintain a high index of suspicion for thyroid swellings which may show foci of tuberculosis, especially if they have an elevated ESR and other foci of tuberculosis.