An infection Burden on thyroid (Tuberculosis of thyroid): A case report

Abstract

Aim: To enlighten the treating physician about the importance of tuberculosis (TB) of thyroid. Background: Though the prevalence of TB is high in country like India, TB affecting the thyroid gland is a rare entity due to inherent antibacterial properties of the gland. A high degree of suspicion and thorough clinical knowledge is absolutely necessary for identification of this entity. Case description: A 55-year-old man presented with 8 weeks’ history of swelling in midline of the neck and 2 weeks’ history of pain over the swelling. Blood investigations including the thyroid profile were normal. Clinical examination was suggestive of infected thyroglossal cyst along with multinodular goiter. Ultrasound confirmed the clinical diagnosis and in addition revealed bilateral cervical lymph nodes. Ultrasound-guided fine-needle aspiration cytology (FNAC) of thyroid was inconclusive and FNAC of lymph nodes showed reactive changes. Patient underwent total thyroidectomy along with Sistrunk operation and biopsy of both right-and left-sided cervical lymph nodes. Incidentally, he was diagnosed with hypocortisolism as the patient went in for hypotension intraoperatively, which was managed appropriately. Histopathology revealed TB of the thyroid. Conclusion: Tuberculosis of thyroid, though a rare entity, should be borne in mind and included in the differential diagnosis, particularly in countries with high TB burden. Clinical significance: Identification of such conditions preoperatively can avoid unnecessary surgeries as these conditions can be managed by medical treatment.