FRI517 BIUX(2)X(2)

Disclosure: K. Dash: None. U. Ayyagari: None. A Rare Presentation of Solitary Thyroid Nodule - Microfilaria: Case reportDash Kalpana,* Ayyagari Usha***Department of Endocrinology & Metabolism, Apollo Hospitals, Bilaspur. Chhattisgarh, India.** Smriti Speciality Klinics, Chennai, IndiaTel: +919827143474, Email: drkdash@rediffmail.com. Introduction: Filariasis is a debilitating public health problem in the tropics most commonly presenting with asymptomatic microfilaremia. Clinical manifestations include lymphangitis/lymphadenitis in lower limbs(elephantiasis), peritoneum, scrotum(hydrocele), and rarely in breast (breast lump), pleural effusion, bone marrow, and thyroid (painless nodule or thyroiditis). Diagnosis is by demonstrating microfilaria in peripheral blood or tissue biopsy or detection of filarial antigen/antibody in blood. Adult worms are found in lymphatics, subcutaneous tissue, peritoneal and pleural fluid, heart, brain, scrotum, breast, and rarely, thyroid. Filariasis may rarely present as superficial swellings at unusual sites. We present a case of filarial thyroid nodule, a rare manifestation of filarial disease. Clinical Case: Female, 72, presented with painless swelling over the thyroid for 6 months. She had no significant past medical history, was otherwise asymptomatic, clinically and biochemically euthyroid, with normal hemogram, RFT, and LFT. Clinical examination revealed a firm, non-tender nodule measuring 35x45mm, moves with deglutition. On USG of neck, a nodular hypoechoic lesion of 41x45mm was seen over right lobe of thyroid with calcification. FNAC was done for suspected carcinoma & showed histiocytes, hurthle cells, giant cells and a single viable Microfilarial form of Wuchereria bancrofti. She was treated with Diethylcarbamazine citrate & made a full recovery with resolution of the nodule. Discussion: We report a rare manifestation of filarial disease as a painless thyroid nodule. Circulating microfilaria reach the thyroid tissue, followed by rupture of vasculature causing local inflammatory reaction and subsequent nodular transformation. Diagnosis presents challenges as the endemic species in India exhibit nocturnal periodicity and it is difficult to find microfilariae in blood and fine-needle aspirates during the day. Case reports of microfilaria in thyroid aspirates from nodules or thyroiditis are rare. Clinical Lesson: The differential diagnosis for a painless thyroid nodule includes possible malignant disease, with the associated stress of further investigation and treatment. However, accurate diagnosis of filarial disease, rare as it may be, even in endemic areas, obviates the need for surgery as evidenced by the resolution of the nodule with medical treatment in our case. Presentation: Friday, June 16, 2023