Lymphoma of the thyroid

In 24 of 30 patients with lymphoma of the thyroid, the diagnosis was made preoperatively or without surgery; undifferentiated or poorly differentiated carcinoma was suspected in 3 other patients. Thirteen patients were under 60 years of age; 7 were under 40. An increase in the ratio of men to women was seen among younger patients. At presentation, a discrete nodule was found in 19 patients, and multinodular or diffuse goiters in 11. Seventy-six percent of patients with solitary nodules had enlargement of extranodular tissue. Imaging showed "cold" nodules, cold areas in diffuse goiters, or patchy uptake. Nine patients had obstructive complaints; 12 patients had subnormal thyroid function; 24 patients had coexistent Hashimoto's thyroiditis. Lymphoma of the thyroid was suggested by fine-needle biopsy results in 17 of 28 patients (undifferentiated carcinoma was suspected in 2); and by large-needle biopsy results in 21 of 23 (undifferentiated or poorly differentiated carcinoma was suspected in 2). Biopsy of diffuse Hashimoto's goiters is indicated for cold imaging defects, enlarging tender goiter, or goiter enlarging on thyroid hormone. Early diagnosis may improve prognosis for lymphoma of the thyroid, so that surgery or chemotherapy can be avoided.