A case of amyloid goiter secondary to Crohn's disease

Concomitant Thyroid Disorders and Inflammatory Bowel Disease: A Literature Review

The aim of this report was to review and summarize the literature on cases of concomitant inflammatory bowel disease (IBD) and thyroid diseases. We included the following previous case reports of concomitant IBD and thyroid diseases: 16 cases of ulcerative colitis (UC) and Graves' disease (GD), 3 cases of Crohn's disease (CD) and GD, 10 cases of CD and Hashimoto's thyroiditis (HT), 4 cases of IBD and subacute thyroiditis (SAT) or SAT-like symptoms, and 13 cases of IBD (12/13 cases were CD) and amyloid goiter. There might be no obvious differences of prevalence of thyroid dysfunction (hyper- or hypothyroidism), GD, and thyroid cancer between IBD patients and general populations. However, concomitant UC and HT might be relatively common in patients with multiple autoimmune disorders, and AG is one of the complications with CD patients. There might be no obvious differences of fatal prognoses between IBD patients with thyroid diseases and patients with thyroid diseases without IBD.

Amyloid goiter related with Crohn's disease: A rare association: Amyloid goiter secondary to Crohn's disease

INTRODUCTION

Amyloid goiter (AG) is characterized by enlargement of the thyroid gland as a result of extensive amyloid deposition in a bilateral and diffuse manner.

PRESENTATION OF CASE

A 58-year-old male patient was diagnosed of Crohn's Disease (CD). He was admitted to our clinic with complaint of respiratory distress and rapid growth swelling in the neck. Ultrasound examination revealed huge multinodular goiter on both sides of thyroid gland. We performed bilateral total thyroidectomy. Pathological evaluation revealed AG.

DISCUSSION

Amyloid leads to degeneration in tissues, thereby disrupts the function of the relevant organs. It is important to distinguish AG from other reasons of goiter, particularly thyroid medullary cancer that can cause amyloid deposition in thyroid gland. Secondary amyloidosis frequently involves thyroid gland at microscopic level, but rarely causes goiter. An analysis of current literature revealed that only few cases of AG occurred secondary to CD. Herein we presented a case of AG who has rapidly growing goiter that associated with CD.

CONCLUSION

AG must be kept in mind in case of rapidly growing goiter, especially in patients with chronic inflammatory bowel diseases.

Localized amyloid in thyroid: are we missing it?

When present in thyroid, amyloid is an attribute almost always restricted to medullary thyroid carcinoma. Scant studies in the literature have demonstrated this finding in other thyroid pathologies as papillary thyroid carcinoma, amyloid goiter, and other benign entities. From our experience in thyroid pathology, we analyzed cases on which the stroma contained deposits of amorphous, acellular, and eosinophilic material characteristic of amyloid. Congo red stain on suspicious cases was performed; clinicopathologic investigation was done when results were positive. Seven patients with amyloid infiltration in the thyroid, in association with papillary thyroid carcinoma, and in 4 cases of benign pathologies were found in our own review. The association of amyloid and thyroid is discussed herein, including cases of systemic amyloidosis, malignancies, benign diseases, and thyroid goiter, from our practice and from the available literature.

Giant amyloid goiter in Crohn's disease

Crohn's disease is one of the causes of secondary amyloidosis, which can lead to amyloid infiltration of the thyroid gland. It is essential to follow strict controls to prevent the appearance of a large amyloid goiter. Two patients with amyloid goiter secondary to Crohn's disease, with a large adipose tissue component and who required surgical treatment, were studied. Both surgical interventions were difficult because of the fragility of the thyroid tissue. A patient with Crohn's disease and secondary amyloidosis could begin to develop amyloid goiter. This is usually fast growing and commonly causes compressive symptoms, although in some cases it only grows in the neck with no evidence of these symptoms. When surgery is indicated, patients should be remitted to hospitals with experienced endocrine surgeons, given that there is a high risk of developing complications.

[Amyloid goiter secondary to Crohn's disease]

Secondary amyloidosis is generally caused by malignant tumors or chronic inflammatory diseases. Most cases of secondary amyloidosis are discovered due to proteinuria or nephrotic syndrome caused by renal amyloidosis. Clinically significant thyroid involvement is found in only a small percentage of cases, although a finding of amyloid deposit in autopsies is not infrequent. We present a case of amyloid goiter. The patient was diagnosed with Crohn's disease 7 years previously and had kidney failure of unknown cause. She was referred to our department for a goiter discovered incidentally. The patient finally underwent thyroidectomy due to progressive growth of the thyroid gland with compressive symptoms. The histologic analysis showed thyroid amyloidosis.

Amyloid goiter: report of two cases and review of the literature

OBJECTIVE

To describe two recent cases of amyloid goiter that occurred in two patients with a history of diffuse enlargement of the thyroid gland, progressing over several years' time.

METHODS

We reviewed the medical histories as well as the histologic, immunohistochemical, and electron microscopic findings in these patients.

RESULTS

Assessment of the clinical records of a 59-year-old man and a 64-year-old woman revealed histories that included chronic psoriasiform arthritis and asthma in conjunction with chronic obstructive pneumonia and bronchiectasis. In both cases, total thyroidectomy was performed. On histologic examination of both thyroid glands, the appearance was characterized by moderate to severe distortion of the normal thyroid architecture by amyloid in a perifollicular distribution and focally abundant interfollicular adipose tissue. In both cases, the amyloid stained intensely positive with Congo red, which bleached after treatment with potassium permanganate. Immunohistochemical staining patterns were consistent with AA amyloid, and electron microscopy showed nonbranching 9-nm fibrils consistent with amyloid.

CONCLUSION

The diagnosis of amyloid goiter should be suspected in patients with a diffusely enlarging thyroid gland and an appropriate clinical history.