[Thyroid tuberculosis; a rare cause of compressive goiter].

Thyroid gland involvement by Koch’s bacillus is an extremely rare condition.1 The number of cases reported in recent years is very low, even in Asiatic areas where the prevalence of tuberculosis is high.2 Differential diagnosis of masses in the midline of the neck should include thyroglossal duct cyst, lipoma, thyroid carcinoma, and cervical adenopathies of thyroid isthmus.3 This condition tends to be underdiagnosed because of the rarity of tuberculous thyroiditis. The case of a 57-year-old male with clinical signs of goiter, neck adenopathies, and dysphagia is reported below. A 57-year-old male born in Bolivia who had been living in Spain for 20 years reported the gradual occurrence during the previous three months of a hard, painless mass in the midline of the neck. During the previous month, stonehard, immobile, and tender right jugular adenopathies had also appeared, associated with progressive dysphagia to solids in the previous weeks. The patient also reported the loss of 10 kg of weight during that period with fever, mainly occurring at night, chills, and profuse sweating with no other associated symptoms. The patient provided the results of tests previously made at another center, including fine needle aspiration leading to a diagnosis of lymphocytic thyroiditis, undetectable anti-thyroid antibodies, and a neck ultrasound showing two masses dependent on the thyroid gland, of which the right lobe mass measured 65mm× 33mm× 19mm in size and the left lobe mass 55mm× 32mm× 40mm. When examined by us, the patient was afebrile and in a good general condition, and was found to have a big suprasternal mass in the anterior neck 6 cm in largest diameter not affecting the overlying skin, mobile upon swallowing, and with no audible murmur or systolic thrill over it (Fig. 1). Hard, painful, and immobile adenopathies 3 cm at largest diameter were also palpated in the right jugular region, as well as multiple 1cm adenopathies in the right supraclavicular region. Chest