SUN-588 Primary Tuberculosis of the Thyroid Gland: A Case Series

Background:Tuberculosis (TB) of the thyroid gland is a rare occurrence even in regions where TB is endemic. This affects about 0.1% of the population with TB and remains to be underdiagnosed due to the rarity of the condition. Case: We report three cases of TB of the thyroid. The first patient is a 60 year old female who presented with anterior neck mass with no obstructive symptoms, neck pain or fever. There were no signs nor symptoms of hyperthyroidism or hypothyroidism. She also has no history of tuberculosis. Ultrasound showed multiple thyroid nodules. Ultrasound guided FNABof the left nodule was done revealing chronic granulomatous inflammation with necrosis. The second case is a 60 year old male presenting with a history of painful, marble-sized right neck mass for 1 month accompanied by occasional low grade fever, weakness and weight loss. An ultrasound guided FNAB was performed revealing polymorphic lymphoid cells with occasional giant cells consistent with granulomatous thyroiditis. The third case is a 37 year old female presenting with an enlarging anterior neck mass with concomitant abscess. She complained of neck pain and dysphagia. Incision and drainage of the abscess was done. Microbiological studies revealed negative AFB with chronic granulomatous lymphadenitis and caseation necrosis. Mycobacterium culture and polymerase chain reaction were negative as well. Ultrasound of the thyroid gland revealed a left thyroid mass measuring 2.1 x 3.5 x 4.1 cm. Result: The first case was referred to an infectious disease specialist but was lost to follow up. The second casecompleted treatment for 6 months with anti Koch’s medications and on repeat ultrasound, there was decrease in the size and number of the nodules. The third case underwent thyroid lobectomy with histopathologic criteria for TB hence a diagnosis of thyroid TB was made. The patient was given anti-Kochs treatment. Conclusion: Though rare, tuberculosis of the thyroid should be one of the differential diagnoses of patients presenting with neck masses in communities where the prevalence of TB is high even in patients with no history of TB.