Thyroid No Surgery: Rare Thyroid Lymphoma Presents with Enlarging Goiter After Years of Hashimoto’s Thyroiditis CHT

Dr.Guttler’s comments:

1.  In 46 years of my thyroidology practice I have diagnosed only a few thyroid lymphomas in my patients. They all had prior diagnosed Hashimoto’s thyroiditis CHT.
2. I saw a 35 Y/O female with long standing hypothyroidism since age 14 with recent growth noted by the patient.
3. She was finally diagnosed as CHT 2 years ago during a pregnancy.
4. The right lobe had a firm nodule to my examination.
5. However the US did not confirm a nodule but a hypoechoic area in the upper pole of the right lobe in the area of the pseudonodule on physical examination.
6. 
7. Although Lymphoma is extremely rare she had a long history of Hashimoto’s goiter.
8. The enlarged firm “pseudonodule” was biopsied and flow cytometry was obtained.
9. A monoclonal B-cell lymphoproliferative disorder with increased larger cells was found.
10. 
11. Further studies need to be done.
12. A cutting needle biopsy is the next test needed.
13. The most frequent cases associated with CHT include non-Hodgkin lymphoma derived from B-cells, mainly diffuse large B-cell lymphoma (DLBCL) followed by mucosa-associated lymphoid tissue (MALT) lymphoma or a mixed type.
14. Lymphomas derived from T-cells and Hodgkin lymphomas are extremely rare.
15. An increased potential exists for a cure without the need for a radical surgical procedure.
16. Modern chemoradiation therapy plus the monoclonal antibody rituximab, which acts against CD20, have limited the need for surgical interventions and provide an excellent outcome in most cases.
17. However, some cases have resulted in treatment failure or recurrence.
18. After the preliminary diagnosis of thyroid lymphoma is made an oncologist/radiotherapist team is need to actually treat the patient.
19. If you have long standing CHT and there is recent growth you need to see a thyroidologist.
20. Call me at 310-393-8860 or thyroid.manager@thyroid.com.
21. Ask for Alicia.
22. Dr.G.

Journal of Investigative Surgery Volume 32, 2019 – Issue 2

page 137-142

A Review of Primary Thyroid Lymphoma: Molecular Factors, Diagnosis and Management