Thyroid tuberculosis: two cases report and review of the literature

Thyroid tuberculosis (TTB) is a rare form of extrapulmonary tuberculosis. We report two cases of young women with this disease. One woman presented with a solid, painless swelling in the left side of the neck, the other woman had a similar swelling in the right side of the neck and some palpable cervical lymph nodes in both sides of the neck. They did not complain dysphagia, dyspnea or any tuberculosis specific symptoms. Neither signs nor symptoms of hypothyroidism or hyperthyroidism were present. Patients had no other tuberculosis focus or history. Chest X-ray was normal. Sputum for acid fast bacilli (AFB) was negative, but tuberculin skin tests (TST) were positive and strongly positive respectively. Ultrasonography revealed a 45 mm × 44 mm × 33 mm hypoechoic mass and might mimic thyroid adenoma on the first woman. On the second woman, Ultrasonography, computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) examinations showed a 18 mm × 15 mm × 15 mm hypoechoic mass and malignant cervical lymphadenectasis. She was made thyroid malignancy in overstage the primary diagnosis. Hemithyroidectomy on the first woman and total thyroidectomy on the second woman were performed. Both histopathologic examinations of the thyroid biopsy material revealed caseating granulomas with epithelioid histiocytes and giant cells. Cultures and stains for AFB in the specimens were either negative. The final diagnosis were TTB, TTB and tuberculosis lymphadenitis respectively. Antituberculous therapies were started after surgery and there was no recurrence in the thyroid lesion during the subsequent regular follow-up in outpatient clinic.