Hashimoto's Thyroiditis Presenting With Recurrent Massive Pleural Effusion Suggestive of Lymphocytic Interstitial Pneumonitis
https://doi.org/10.15605/jafes.041.S1
- Author:
Endah Pratamaningtias
1
;
Nyoman Satvika Dharma Yudha
1
Author Information
1. Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Saiful Anwar HospitalFaculty of Medicine Brawijaya University, Indonesia
- Publication Type:Journal Article
- MeSH:
Lung Diseases, Interstitial;
Pleural Effusion;
Thyroiditis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):106-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Hashimoto's thyroiditis is a common autoimmune thyroid
disease; however, pulmonary involvement is a rare
manifestation. Lymphocytic interstitial pneumonitis is
commonly associated with autoimmune diseases, but its
association with Hashimoto's thyroiditis remains poorly
understood.
Case:A 63-year-old male with prior diagnosis of Hashimoto's
thyroiditis presented with recurrent massive pleural
effusion and progressive dyspnea. He also experienced
fatigue, cold intolerance, and constipation. Physical
examination revealed facial puffiness, diffuse goiter, and
dry skin. Thyroid function tests performed 6 months before
admission confirmed overt hypothyroidism (thyroidstimulating hormone [TSH] 80.30 µIU/mL, free thyroxine
4 [FT4] 0.46 ng/dL). One month prior to admission,
laboratory findings showed subclinical hypothyroidism
(TSH 9.09 µIU/mL, FT4 1.42 ng/dL). Despite levothyroxine
treatment TSH levels remained elevated at 21.8 µIU/mL
during admission. Anti-thyroid peroxidase antibodies were
positive (13.95 IU/mL). Repeated thoracentesis revealed
exudative pleural effusion with lymphocytic predominance
and no evidence of malignancy in cytological examination.
Infectious etiologies and malignancy were ruled out.
Thyroid ultrasonography demonstrated diffuse hypoechoic
enlargement of the thyroid gland. Chest radiography
showed massive unilateral pleural effusion, while thoracic
computed tomography revealed ground-glass opacities
with a reticulogranular pattern and interlobular septal thickening, accompanied by multiple thin-walled cysts,
highly suggestive of lymphocytic interstitial pneumonitis.
Thyroid immunohistochemical analysis was performed
(CD 20, CD 3, CD 10, CD 138, Ki 67, BCL 2, BCL 6,
Thyroglobulin, MUM 1, Cyclin D1), consistent with
lymphocytic thyroiditis. Significant clinical and laboratory
improvement was achieved after combined treatment with
levothyroxine and corticosteroid.
Conclusion:This case underscores the importance of considering
autoimmune-related lymphocytic interstitial pneumonitis
in patients with Hashimoto's thyroiditis who present with
unexplained recurrent pleural effusion after exclusion of
more common etiologies, such as infection and malignancy.
Early recognition may lead to favorable improvement.
- Full text:2026080417084519975EP_A155.pdf
