AMYLOID GOITER AS THE FIRST RECOGNIZABLE MANIFESTATION OF IMMUNOGLOBULIN LIGHT CHAIN AMYLOIDOSIS
AACE Clinical Case Reports
|January 23, 2020
Summary
Amyloid goiter, a rare thyroid enlargement from amyloid deposition, can be diagnosed via fine-needle aspiration. This case highlights its association with light chain amyloidosis and monoclonal gammopathy, emphasizing its importance in differential diagnosis.
Area of Science:
- Endocrinology
- Pathology
- Oncology
Background:
- Amyloid goiter, characterized by significant amyloid deposition in the thyroid, is an uncommon manifestation of systemic amyloidosis.
- Endocrinologists must recognize amyloid goiter as a potential sign of underlying systemic disease.
Observation:
- A 70-year-old man presented with a slowly enlarging, asymptomatic, multinodular goiter.
- Initial cytology showed atypia of undetermined significance (Bethesda System category III).
- Thyroid miRNA testing was negative.
Findings:
- Thyroid lobectomy revealed nodular hyperplasia with significant amyloid deposition confirmed by Congo red staining.
- Mass spectrometry identified light chain amyloidosis (lambda type).
- Retrospective review revealed cardiac amyloidosis and monoclonal gammopathy of unknown significance.
Implications:
- Amyloid goiter should be considered in the differential diagnosis of enlarging goiters with Bethesda category III cytology.
- Diagnosis is crucial for patients with systemic amyloidosis or monoclonal gammopathy.
- Early recognition aids in managing underlying systemic disease.
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