Title : Unraveling a case of tubercular thyroiditis presenting as thyrotoxicosis
Abstract:
Introduction: Tuberculosis is chronic infection caused by mycobacterium tuberculosis and primarily attacks the lung. Tuberculosis of thyroid gland is an uncommon entity as the gland is resistant to infection due to bactericidal property of colloid high iodine content and extensive vascularity.
We hereby present the case of 34 year old male who presented to us with fever, loss of weight and tremors of both upper limbs for past 2 months. Fever was intermittent with one to two spikes per day associated with evening rise of temperature and night sweats. He gave history of significant weight loss of around 7kg loss over past 2 months which was associated with loss of appetite. He also had tremors of both the hands which aggrevated on activity that affected his daily routine life. His past history was unremarkable. On examination he had pallor cervical and axillary lymphadenopathy and anterior neck swelling moving with deglutition and had tachycardia. Systemic examination revealed hepato-splenomegaly. On investigating he had anaemia with elevated ESR. Thyroid function test revealed low tsh and elevated ft4 suggestive of hyperthyroidism, ultrasonography of neck was suggestive of thyroiditis and initial FNAC showed Bethesda category 2. Whole body Pet-Ct scan revealed bulky right lobe of thyroid gland and increased metabolically activity in axillary, gastrohepatic, perigastric, paratracheal lymphnodes and segment 6 and 8 of liver. Histopathological examination of axillary lymph node revealed sinus histiocytosis and thyroid gland revealed multiple caseating granulomas consistent with tuberculosis. Patient was hence diagnosed as case of tubercular thyroiditis presenting as thyrotoxicosis with disseminated tuberculosis and was initiated on antitubercular drugs
Discussion: Tuberculosis is endemic in India and can affect any organ of the body Tubercular involvement of thyroid gland maybe either primary or as a part disseminated disease process in immunocompromised individuals and most cases are euthyroid. Tuberculosis of thyroid gland should be considered in differential diagnosis when evaluating a thyroid nodule especially in presence of lymphadenopathy organomegaly and anemia with elevated ESR and should be extensively evaluated.
