[A Somali man with a painful thyroid mass: thyroid tuberculosis]

A 21-year-old man from Somalia presented with a painful mass in the thyroid, 6 months offatigue, weight loss and fever. Two separate courses of antibiotics did not improve his condition. Thyroid function tests were normal. The chest X-ray showed an enlarged hilus with some pulmonary infiltration around it. The diagnosis ofthyroid tuberculosis was established by cytological, microbiological and PCR testing of a fine needle aspirate of a thyroid lymph node. Treatment with antituberculosis agents resulted in a complete clinical response. The differential diagnosis of a painful thyroid mass encompasses subacute granulomatous thyroiditis, infectious thyroiditis, radiation- or trauma-induced thyroiditis and haemorrhage in the thyroid lymph nodes. Although thyroid tuberculosis is mainly a disease of developing countries, increasing immigration can lead to a higher incidence of this rare form of extrapulmonary tuberculosis and should therefore also be considered in patients with a painful thyroid mass.