Lymphocytic Turned Lymphomatous: A Case of Hashimoto's Thyroiditis
https://doi.org/10.15605/jafes.041.S1
- Author:
Suprhamanyam Evali
1
;
Amie-Anne Augustine
1
;
Shamharini Nagaratnam
1
Author Information
1. Endocrine Institute, Hospital Putrajaya
- Publication Type:Journal Article
- MeSH:
Thyroiditis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):110-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Primary thyroid lymphoma (PTL) is a rare malignancy
representing 1–5% of all thyroid cancers, most frequently
arising on a background of chronic autoimmune thyroiditis.
Case:We report a 73-year-old Malay male who initially
presented with large goiter, symptomatic bradycardia, and
subsequently developed severe primary hypothyroidism
(thyroid-stimulating hormone 231 mIU/L, anti-thyroid
peroxidase 643 IU/mL), consistent with Hashimoto’s
thyroiditis. During his clinical course, he also sustained
a non-ST elevation Myocardial Infarction which was
attributed to demand-supply mismatch of hypothyroidism.
Computed tomography scan of the neck revealed a large
multinodular goiter with retrosternal extension, tracheal
compression, and extensive nodal lymphadenopathy.
Initial Fine needle biopsy was non-diagnostic, but a repeat
biopsy was performed due to rapidly enlarging goiter
within weeks with suspicious nodules seen on bedside
thyroid ultrasound. Ultrasound-guided core biopsy
confirmed Diffuse Large B-cell Lymphoma (DLBCL),
non-germinal centre B-cell (non-GCB) subtype. Despite
initiation of levothyroxine and corticosteroid therapy, the
patient deteriorated with remarkable rapidity over the
ensuing weeks, culminating in a 15 × 10 cm compressive
neck mass, Type 1 respiratory failure, hypercalcemia,
complete dysphagia, and concurrent pneumonia. He
was then transferred to hematology tertiary centre for
commencement of his chemotherapy.
Conclusion:This case of PTL presenting in the background of
Hashimoto’s thyroiditis emphasizes the role of early
tissue diagnosis in patients with rapidly enlarging goiter.
Identification of PTL is critical because management shifts
from surgical intervention to systemic chemotherapy.
- Full text:2026080508340927662EP_A162.pdf
