Abstract
Objective: Tuberculosis of thyroid gland is encountered in only 0.1% - 0.4% thyroid biopsies. We are presenting a case to emphasize inclusion of this rare disorder as a potential differential diagnosis during the assessment of thyroid lesions. Case report: 38-year female presented with a cystic nodule of left lobe of thyroid. Guided aspiration yielded only necrosed material. Biopsy revealed caseating granuloma with giant cells. Tuberculosis etiology was confirmed by PCR examination. Conclusion: Thyroid tuberculosis should always be considered as a probability during assessment of any midline cervical mass. Pre-operative diagnosis can avoid unnecessary surgery.
Highlights
IntroductionBefore demonstration of glandular involvement in a case of disseminated tuberculosis by Lebert (1862), thyroid gland was considered immune from the disease [3]
Tuberculous thyroiditis is infrequently reported even from endemic areas [1,2]
Before demonstration of glandular involvement in a case of disseminated tuberculosis by Lebert (1862), thyroid gland was considered immune from the disease [3]
Summary
Before demonstration of glandular involvement in a case of disseminated tuberculosis by Lebert (1862), thyroid gland was considered immune from the disease [3]. Bruns (1893) reported similar involvement without any evidence of military or pulmonary tuberculosis [4]. Possible attributable factors for relative resistance to infection can be intact thyroid capsule; rich vascular and lymphatic supply; high iodine content of the gland; bactericidal activity of colloid and thyroid hormones; enhanced phagocytic activity of gland macrophages as seen during hyperthyroidism [1,2]. Primary involvement of the thyroid gland can only be explained as reactivation of the latent focus of infection [4]. Secondary involvement can be haematogenous or lymphatic from distant sites (lung) or directly from local sites (larynx, lymph nodes), occurring during progressive infection [1,4]
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