Thyroid Involvement Research Articles

Graves’ Disease in Pregnancy: A Systematic Review

Introduction: Graves’ disease is an autoimmune disease that is associated with thyroid gland involvement and is most common in young women. During pregnancy, it is the main cause of hyperthyroidism, as the thyroid gland volume and thyroid hormone synthesis increase. Changes in the immune system during pregnancy can affect the onset of disease. During pregnancy, the pathological cause of Graves’ disease is immune deficiency. This study investigated changes in the thyroid gland occurring during pregnancy, the causes of Graves’ disease during pregnancy, and its diagnosis and treatment. Methods: A search of Google scholar, Ovid, and MEDLINE was conducted with the search terms Graves’ disease, pregnancy, and treatment. Results: A total of 65 titles were initially identified with the search strategy described. Twenty-five publications were excluded. Out of the remaining articles, 19 articles were used in terms of content. Treatment for Graves’ disease is determined according to the patient’s condition, the priority of the patient, and the resources available. Treatments include oral anti-thyroid drugs (ATDs), radioactive iodine, and surgical procedures. Among the oral prophylactic drugs, Propylthiouracil is used during lactation. Radioactive iodine is not used during pregnancy or lactation. Thyroidectomy is better to be used in the third trimester of pregnancy. Conclusion: The treatment of Graves’ disease is very important; if not treated, this disease causes many complications with the fetus. After delivery, the mother and the baby should be monitored for thyroid problems. Pre- and postpartum planning and the effective management of Graves’ disease in women of childbearing age are necessary to prevent the pathogenesis of Graves’ disease during pregnancy.

Immunoglobulin G4 related thyroid disorders: Diagnostic challenges and clinical outcomes.

Ig-G4 related disease (IgG4RD) is a heterogeneous disorder with multi-organ involvement recognised as a separate entity at the start of this century only. It is currently one of the hottest areas of clinical and translational research across specialties. Thyroid involvement in IgG4RD is rare, believed to occur in less than 4% of cases, may be isolated or may be associated with other organ involvement. As of today Riedel's thyroiditis, fibrosing variant of Hashimoto's thyroiditis, and few patients of Graves' orbitopathy represent the types of IgG4-related thyroid disease (IgG4RTD). This disorder is frequently confused with malignancy due to the intense sclerosis of thyroid resulting in hard texture on palpation compounded by often-associated compressive symptoms. Diagnosis involves establishing high circulating levels of IgG4 > 135 mg/dL, increased serum IgG4 to IgG ratio of > 8%, immunohistochemistry showing dense lymphoplasmacellular inflammatory infiltrate consisting of IgG4-positive plasma cells with storiform fibrosis and obliterative phlebitis, and increased IgG4 positive plasma cell > 10 cells per high-power field when at least three fields are evaluated. Glucocorticoids are the primary form of therapy in IgG4RD. However, their role in IgG4RTD needs to be evaluated. As of today levothyroxine supplementation for resulting hypothyroidism, appropriate management of Graves' disease, and surgical excision of thyroid in case of compressive symptoms remain the primary treatment options. (Endokrynol Pol 2016; 67 (5): 520-524).

Primary rhabdomyosarcoma of the thyroid in an adult with auricular thrombosis

IntroductionRhabdomyoscarcoma (RMS) is the most common soft-part tumour in children, however, it is infrequent in adults. Thyroid involvement is exceptional and only four cases have been reported: two primary RMS in children and another two cases in young adults with RMS metastasis to the thyroid. We report the first case in the literature of a primary adult RMS with thyroid involvement and superior vena cava syndrome. Case presentationA 67-year-old male was admitted for an oedema of the arm extending to the laterocervical region. Computed tomography showed a 6cm mass in the hemithyroid with venous thrombosis to the auricle. Fine-needle aspiration was compatible with Bethesda category III. Surgery revealed a stone-hard consistency thyroid. An intraoperative biopsy showed an undifferentiated neoplasia, and no additional surgical intervention was undertaken. The patient died 48hours later. Definitive histology showed a RMS. DiscussionVenous thrombosis due to a thyroid tumour is infrequent. The scarce information in the literature recommends that thyroid carcinomas with auricular thrombosis be resected as soon as they are diagnosed. However, in cases of anaplastic or poorly differentiated carcinomas is controversial. Had there been a preoperative diagnosis in the histology in our case, surgery would not have been indicated.

An unusual case of adult onset multi-systemic Langerhans cell histiocytosis with perianal and subsequent incident thyroid involvement

An unusual case of adult onset multi-systemic Langerhans cell histiocytosis with perianal and subsequent incident thyroid involvement

Thyroid Gland Involvement in Carcinoma Larynx and Hypopharynx-Predictive Factors and Prognostic Significance.

Intraoperative management of thyroid gland in laryngeal and hypopharyngeal cancer is controversial. The objectives of this study were to determine the incidence of thyroid gland invasion in patients undergoing surgery for laryngeal or hypopharyngeal carcinoma, to assess predictive factors and to assess the prognosis in patients with and without thyroid gland invasion. One hundred and thirty-three patients who underwent surgery for carcinoma larynx and hypopharynx from 2006 to 2010 were reviewed retrospectively. Surgical specimens were examined to determine the incidence of thyroid gland invasion and predictive factors were analysed. The recurrence rate and the survival in patients with and without thyroid gland invasion were also analysed. Out of the 133 patients with carcinoma larynx and hypopharynx who underwent surgery, histological thyroid gland invasion was observed in 28/133 (21%) patients. Significant relationship was found between histological thyroid gland invasion and preoperative evidence of thyroid cartilage erosion by CT scan and also when gross thyroid gland involvement observed during surgery. There is significant association between thyroid gland invasion when there is upper oesophageal or subglottic involvement. After analysing the retrospective data from our study, we would like to suggest that thyroid gland need not be removed routinely in all laryngectomies, unless there is advanced disease with thyroid cartilage erosion and gross thyroid gland involvement or disease with significant subglottic or oesophageal involvement.

Nodular Lymphocyte Predominant Hodgkin Lymphoma of the Thyroid

Thyroid lymphomas are rare clinical entities that may result from either the primary intrathyroid de novo or secondary thyroid gland involvement of a lymphoma. Among these, the Hodgkin's subtype is quite uncommon, accounting for 0.6–5% of all thyroid malignancies. The authors report on a 76-year-old female presenting with a thyroid nodule that, upon surgical excision, was found to be a nodular lymphocyte predominant Hodgkin lymphoma of the thyroid. So far, thyroid involvement by this variant has never been reported. Upon reporting on this clinical case, the authors emphasize the difficulties usually found in establishing the diagnosis and in defining the best management strategy. A thorough review of the available literature is done.

Pathology of thyroid in acquired immunodeficiency syndrome.

The course of human immunodeficiency virus infection and the acquired immunodeficiency syndrome can be complicated by a variety of endocrine abnormalities, including abnormalities of thyroid gland. This study was designed to understand the spectrum of pathology of thyroid in Indian patients with AIDS. The present study describes the findings of retrospective autopsy findings of 158 patients with AIDS which revealed infectious diseases from a time period before the use of highly active antiretroviral regimen. A wide range of bacterial, fungal, and viral infections were observed. Tuberculosis was recorded in 14 (09%) patients, Cryptococcus neoformans in 11 (7%) patients and cytomegalovirus in 3 (2%) patients. Hashimoto's thyroiditis and lymphocytic thyroiditis were seen in 02 (01%) patients each. One patient had dual infection comprising of tuberculosis and cytomegalovirus infection. The other microscopic findings observed were goiter (2 patients), interstitial fibrosis in thyroid (7 patients), and calcification in thyroid (8 patients). Abnormalities of thyroid are uncommon findings in patients with HIV infection however several case reports of thyroid involvement by infectious agents and neoplasm are described in these patients; hence patients with HIV infection should be closely followed up for development of goiter or abnormalities of thyroid functions.

Management of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma.

The objective of this study was to determine the incidence of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma; and the association between clinicopathological parameters and thyroid gland invasion. Medical records of 75 patients with laryngeal and hypopharyngeal squamous cell carcinoma who underwent total laryngectomy with thyroidectomy were reviewed, retrospectively. Preoperative computed tomography scans, clinical and operative findings, and histopathological data of the specimens were evaluated. There were 73 male and two female patients with an age range of 41-88 years (mean 60.4 years). Hemithyroidectomy was performed in 62 (82.7 %) and total thyroidectomy was performed in 13 patients (17.3 %). Four patients had histopathologically proven thyroid gland invasion (5.3 %). In three patients, thyroid gland involvement was by means of direct invasion. Thyroid gland invasion was significantly correlated with thyroid cartilage invasion. Therefore, prophylactic thyroidectomy should not be a part of the treatment policy for these tumors.

A Rare Presentation of Lymphoma: Pancreatic and Thyroid Involvement

Primary thyroid lymphoma is a rare form of thyroid malignancies. It is usually seen in middle aged and elderly females. Its diagnosis is not always easy because it is rare and has not specific signs and symptoms. The risk of development of thyroid lymphoma is higher after Hashimoto’s thyroiditis. The most common form of thyroid lymphoma is diffuse large B cell lymphoma. Patients may present with obstructive symptoms due to progressive growth of mass. In the present report, we aimed to present a 59-year-old female patient admitted with rapidly growing neck mass, severe dyspnea, stridor and dysphagia.

Technetium-99m thyroid scan; does it have a diagnostic aid in sub-clinical auto-immune thyroid disease in systemic lupus erythematosus patients?

Technetium-99m (Tc-99m) thyroid scintigraphy is a well known diagnostic tool that shows the entire gland in a single image. We aimed to evaluate its additive diagnostic value in subclinical autoimmune thyroid disease (S-AITD) in systemic lupus erythematosus (SLE) patients. We investigated 100 systemic lupus erythematosus (SLE) patients without overt thyroid involvement (eight men and 92 women; mean age 40±6.5 years) and 50 age and sex matched controls. All were subjected to thyroid evaluation using anti-thyroglobulin (anti-TG) and anti-thyroid peroxidase (anti-TPO) antibodies; hormones (FT3; FT4 and TSH) and Tc-99m thyroid scintigraphy. 14/100 (14%) and none (0%) were positive for S-AITD in SLE and control groups, respectively (P = 0.0001). They were classified by thyroid scintigraphy and hormonal profile into 2/14 Hashimoto; 10/14 atrophic thyroiditis and 2/14 Graves' disease. Anti-TPO was elevated in 12 SLE cases, while anti-TG was elevated in only 2/14 (P = 0.0001). Thyroid scintigraphy showed statistically significant associations with FT4, TSH and anti-TPO. Tc-99m thyroid scintigraphy may have an additional diagnostic role in S-AITD among SLE patients, with an impact on patient management. This potential needs to be further evaluated in a larger series on a multicenter basis.

Incidental Thyroid Nodules Detected on Thoracic Contrast-Enhanced CT in the Pediatric Population: Prevalence and Outcomes.

The purpose of this study was to investigate the prevalence and outcomes of incidental thyroid nodules detected on thoracic contrast-enhanced CT (CECT) in the pediatric population. We used our hospital information system to retrospectively identify all consecutive pediatric patients (< 21 years old) with newly detected thyroid nodules reported on thoracic CECT performed between January 2006 and January 2013. The study population was categorized into two groups: patients with (group 1) and without (group 2) an available follow-up thyroid ultrasound study. Two pediatric radiologists systematically reviewed the CT studies, available follow-up thyroid ultrasound studies, and outcomes of patients meeting the inclusion criteria. For patients without an available follow-up ultrasound study (group 2), the duration of clinical follow-up was also evaluated. If a biopsy was performed, the pathologic diagnosis was correlated with the imaging findings. The study population consisted of 35 thoracic CECT studies from 35 pediatric patients (18 females, 17 males; mean age, 13 ± 6.2 [SD] years) who met the inclusion criteria. The prevalence of incidental thyroid nodules detected on thoracic CECT in our study population was 1.4% (35/2525 patients; 95% CI, 1-2%). Seventeen of the 35 (49%) patients (group 1) underwent follow-up thyroid ultrasound, six (17%) of whom ultimately underwent biopsy of the thyroid nodule for pathologic diagnosis. Among these six patients, two (33%) were found to have malignant thyroid nodules: papillary thyroid carcinoma and thyroid involvement by an underlying Burkitt lymphoma. Therefore, the prevalence of malignancy among incidentally detected thyroid nodules on thoracic CECT in pediatric patients in this study was 5.7% (2/35 patients; 95% CI, 2-18%). The remaining four of six patients (67%) had benign thyroid nodules. Eighteen of the 35 (51%) patients (group 2) had only clinical follow-up information (mean follow-up, 27.1 ± 21.1 months); no neoplasm subsequently developed from incidentally detected thyroid nodules among this subset. Thyroid nodules detected incidentally on thoracic CECT are rare in pediatric patients. However, when thyroid nodules are present, ultrasound (with or without biopsy for pathologic evaluation) is an appropriate strategy because of the rare but real possibility of an underlying thyroid malignancy in the pediatric population.

Exploring new pharmacology and toxicological screening and safety evaluation of one widely used formulation of Nidrakar Bati from South Asia region.

BackgroundNidrakar Bati (NKB) is an herbal remedy consisted with seven medicinal herbs widely used to cure Somnifacient (sleeping aid) in South Asia as Ayurvedic medicinal system. In the present study, pharmacological and toxicological effects of this medicine was investigated in mice to validate the safety and efficacy of the herb.MethodsOrganic solvent extracts NKB were prepared using maceration method. Effect of extracts on the central nervous system was evaluated using hypnotic activity assay. Effect of the extracts on metabolic activity, assessing involvement of thyroid was conducted using hypoxia test. analgesic and anti-inflammatory activities were assessed in mice using acetic acid induced writhing, formalin induced paw edema, xylene induced ear edema assays. Anxiolytic activity was performed using plus maze, climbing out and forced swimming tests. Effect of the extracts on psychopharmacological effect was carried out using locomotor activity tests (open field, Hole-board and Hole-cross tests). Neuropharmacological effect of the extracts was performed using motor coordination (rotarod test). Toxicological potential of the extract was evaluated using gastro-intestinal activity (gastric emptying and gastrointestinal motility tests).ResultsThe studied formulation reduced the CNS stimulant effects dose independently. In the hypoxia test, only a dose of 100 mg/kg of NKB decreased the survival time. Orally administration of the NKB (200 and 400 mg/kg) produced significant inhibition (P < 0.01) of the acetic acid-induced writhing in mice and suppressed xylene induced ear edema and formalin-induced licking response of animals in both phases of the test. NKB showed locomotor activity (p < 0.05) both in higher and lower doses (100 and 400 mg/kg). NKB increased the total ambulation dose dependently (p < 0.05). NKB, at all tested doses (100, 200 and 400 mg/kg) increased some locomotion activity parameters (ambulation, head dipping and emotional defecation) in hole board test. At higher doses (200 and 400 mg/kg), NKB showed a significant increase in hole cross test. NKB showed an increase in the time on the open arms of the maze at low to medium doses (100 and 200 mg/kg). When using the Rotarod method, NKB showed a considerable increase on motor coordination of the mice. NKB produced marked gastric emptying effect and decreased gastrointestinal motility in mice at low dose.ConclusionsNKB demonstrated various pharmacological effects and toxicological effects due to presence of several herbs in the formulation those are not closely fit for the effect of CNS depressants.

Thyroid nodule: first manifestation of chronic lymphocytic leukaemia

The presence of chronic lymphocytic leukaemia (CLL) cells in the thyroid gland is most likely due to a secondary involvement by a systemic disease. The reported incidence of CLL involving the thyroid is extremely low, representing about 3-4% of all thyroid lymphoproliferative neoplasm. We report a rare case of CLL presenting initially in the thyroid gland. Systemic disease was detected as a result of thyroid investigation. An 85 years old woman, with multinodular goiter without adenophaties, was referred to our department, carrying a fine needle aspiration biopsy (FNAB) report of a private institution referring "lymphoid monomorphic proliferation" and suggesting a "Core-needle biopsy" for further investigation. She was euthyroid (TSH-0.5 uU/mL (0.4-4.0), thyroid antibodies negative, including TRab). The patient denied systemic symptoms and at physical examination there were no adenophaties or organomegalies. FNAB analysis was repeated. Although the patient denied constitutional symptoms and there were no relevant findings in physical examination, technetium 99m thyroid gamagraphy (GG) and blood count were additionally asked. FNAB analysis concluded lymphocytic tiroiditis, but thyroid GG revelled global hypocaptation and blood count showed 173.4 x 109 leukocyte/L with 94% lymphocyte. An ecoguided FNAB with flow cytometry identified thyroid infiltration by monotonous population of blasts with phenotype consistent with CLL/malignancy of mature B-cells. CLL/malignancy of mature B-cells was also detected in peripheral blood analysis, suggesting systemic disease with secondary thyroid involvement. The patient started chemotherapy with rituximab and chlorambucil with good response. Pos-treatment GG revelled "Increased levels of uptake in the middle third of the right lower lobe, with low uptake of the remaining parenchyma". In conclusion, good communication with the pathologist can improve diagnostic accuracy and dictate appropriate therapy. The use of techniques such as flow cytometry, immunoglobulin gene rearrangements, and immunohistochemistry has improved diagnostic accuracy and obviated more invasive procedures, such as core needle or open surgery biopsy. Apart from chemotherapy, immunochemotherapy with anti-CD20 and anti-CD52 monoclonal antibodies can be used in the treatment of CLL.

Imaging Findings in a Case of Mycosis Fungoides

Observation: Mycosis fungoides is a type of malignant T-cell lymphoma that primarily involves the skin. In its later stages, mycosis fungoides can cause peripheral lymphadenopathy and also progress to widespread extracutaneous visceral involvement. The cutaneous lesions including patches, plaques, or erythroderma show no abnormalities at CT. In the stage of tumor formation, thickening or a mass of the skin is seen at CT. Evaluation of extracutaneous involvement, disease progression, and stage is the most important role of imaging in mycosis fungoides. Extracutaneous involvement causes a dramatic decrease in the survival rate. Therefore, CT demonstration of clinically unsuspected lymphadenopathy or abnormality in visceral organs such as hepatosplenomegaly is important. We report the imaging findings of a patient of mycosis fungoides with extensive cutaneous, nodal and visceral and unusual thyroid gland involvement.

Unusual case of Hodgkin lymphoma presenting as soft tissue mass with intracranial metastasis and review of literature

Hodgkin lymphoma (HL) primarily presents as nodal disease and may involve extranodal sites during the progression of the disease. Extra nodal involvement of lung, gastrointestinal tract, testis and thyroid etc., is well-recognized in non-HL but clinically detectable soft tissue involvement is rare and quite exceptional with HL. We report here an unusual case of a young adult male, who presented with a frontal soft tissue mass associated with cervical lymph node. Histopathology supplemented with immunohistochemistry revealed classical HL. Patient did not respond to treatment adequately, and he developed intracranial metastasis during the course of treatment.

Predictors of thyroid gland involvement in hypopharyngeal squamous cell carcinoma.

PurposeDecision to perform concurrent ipsilateral thyroidectomy on patients with hypopharyngeal cancer is important, and unnecessary thyroidectomy should be avoided if oncologically feasible. We hypothesized that concurrent ipsilateral thyroidectomy is not routinely required to prevent occult metastasis. This study aimed to determine the prevalence of histological thyroid invasion in patients with hypopharyngeal cancer, and to refine the indications for prophylactic ipsilateral thyroidectomy in patients with hypopharyngeal cancer.Materials and MethodsA retrospective review of the medical records from the Department of Otolaryngology at Yonsei University College of Medicine was conducted from January 1994 to December 2009. A total of 49 patients underwent laryngopharyngectomy with thyroidectomy as a primary treatment of hypopharyngeal cancer.ResultsThe incidence of thyroid gland involvement was 10.2%. The most common route of invasion was direct extension through the thyroid cartilage. Thyroid cartilage invasion (p=0.034) was the most significant factor associated with thyroid invasion. Disease-specific survival at 5 years was lower in patients with than without thyroid gland invasion (26.7% vs. 55.2%, respectively; p=0.032). Disease-free survival at 5 years was also lower in patients with than without thyroid gland invasion (20.0% vs. 52.1%, respectively; p=0.024).ConclusionIpsilateral thyroidectomy in combination with total laryngopharyngectomy is indicated when invasion of the thyroid cartilage is suspected in patients with hypopharyngeal cancer.

Thyroid Tuberculosis: Yes, It is True

ABSTRACT Tuberculosis of the thyroid gland is an uncommon disease and primary involvement of thyroid is even rarer. It is very uncommon disease even in countries where tuberculosis is endemic. Histologically, the presence of necrotizing epithelioid cell granulomas along with Langhans-type giant cells are the hallmark features of thyroid tuberculosis. In this case report, we are presenting a rare case of thyroid tuberculosis in a 40-year-old female. How to cite this article Gupta R, Mohindroo NK, Azad R. Thyroid Tuberculosis: Yes, It is True. Int J Head Neck Surg 2015;6(4):193-194.

Diffuse large B-cell lymphoma of the thyroid: Seven cases with review of the literature from India

Background: Diffuse large B-cell lymphoma (DLBCL) is the most frequent subtype of nonHodgkin's lymphoma globally with frequent extra nodal involvement. There is sporadic data available on thyroid DLBCL in Indian population and hence we undertook this retrospective observational study at Kidwai Memorial Institute of Oncology, a tertiary care oncology center in India to analyze the clinico biological features of this disease. Methodology: A total of 7 consecutive cases diagnosed as DLBCL by appropriate lymph node biopsy with evidence of thyroid involvement on fine-needle aspiration cytology of thyroid or thyroid histopathology (following thyroidectomy) were confirmed by immunohistochemistry (WHO classification) between January 2008 and September 2013 were included in this study. Results: A total of 7 patients were included in the study. Median age was 65-years (range: 50-72 years), and all were females. Six out of seven were in stage IIAE and one was in stage IVAE. The distribution according to the international prognostic index was as follows: 3 were in low risk, 1 in low-intermediate, 2 in high-intermediate and 1 in high risk group. Regarding treatment, 5 received CHOP, 1 received COP and 1 received no treatment. 5 patients received radiotherapy. 2 patients underwent subtotal thyroidectomy. Of the 6 patients who received chemotherapy ΁ radiotherapy, 4 had complete response 1 was lost to follow-up at 3 months and 1 alive with no disease at 32 months), 2 had partial response. The median survival was 15 months (3-32 months). Conclusions: Extranodal thyroid DLBCL presents common in elderly age group and in females. A multimodality treatment approach is used to treat this entity and may improve survival compared with unimodality approach.

Hepatitis C virus syndrome: A constellation of organ- and non-organ specific autoimmune disorders, B-cell non-Hodgkin's lymphoma, and cancer.

The clinical course of chronic hepatitis C virus (HCV) infection is characterized by possible development of both liver and extrahepatic disorders. The tropism of HCV for the lymphoid tissue is responsible for several immune-mediated disorders; a poly-oligoclonal B-lymphocyte expansion, commonly observed in a high proportion of patients with HCV infection, are responsible for the production of different autoantibodies and immune-complexes, such as mixed cryoglobulins. These serological alterations may characterize a variety of autoimmune or neoplastic diseases. Cryoglobulinemic vasculitis due to small-vessel deposition of circulating mixed cryoglobulins is the prototype of HCV-driven immune-mediated and lymphoproliferative disorders; interestingly, in some cases the disease may evolve to frank malignant lymphoma. In addition, HCV shows an oncogenic potential as suggested by several clinico-epidemiological and laboratory studies; in addition to hepatocellular carcinoma that represents the most frequent HCV-related malignancy, a causative role of HCV has been largely demonstrated in a significant percentage of patients with isolated B-cells non-Hodgkin's lymphomas. The same virus may be also involved in the pathogenesis of papillary thyroid cancer, a rare neoplastic condition that may complicate HCV-related thyroid involvement. Patients with HCV infection are frequently asymptomatic or may develop only hepatic alteration, while a limited but clinically relevant number can develop one or more autoimmune and/or neoplastic disorders. Given the large variability of their prevalence among patients' populations from different countries, it is possible to hypothesize a potential role of other co-factors, i.e., genetic and/or environmental, in the pathogenesis of HCV-related extra-hepatic diseases.

Solitary extramedullary plasmocytoma of the thyroid: a case report and histological approach to plasma cells infiltrate in the thyroid gland

Background:Solitary extramedullary plasmacytoma (SEP) is a rare malignant neoplasm arising from plasma cells. SEP mostly occurs in the upper respiratory tract. Thyroid gland is rarely affected (<78 cases).Methods/results:We describe the case of a 78-year-old woman presenting a rapidly enlarging palpable thyroid mass. Neck computed tomography scan showed enlargement of both thyroid lobes. Laboratory tests were normal, including serum protein level with no monoclonal gamma globulin peak. Cytology was suspicious for lymphoma. Biopsy showed an infiltrating neoplasm composed of atypical tumor cells with abundant cytoplasm and eccentric nuclei. These revealed diffuse immunoreactivity for CD138 and predominant staining for immunoglobulin kappa light chains. Clinical workup for multiple myeloma was negative.Conclusions:SEP should be considered in the differential diagnosis of a rapidly enlarging thyroid nodule and be distinguished from involvement of thyroid in multiple myeloma, mucosa-associated lymphoid tissue lymphoma, plasma cell granuloma and medullary carcinoma. Clinical correlation and immunohistochemistry are crucial in avoiding pitfalls.