Primary Thyroid Lymphoma: A Case Report

Abstract

Background. Primary thyroid lymphoma (PTL) is a rare thyroid gland malignancy. In addition to airway compression symptoms and signs, which are the most common clinical findings, PTL may present with hypothyroidism or B symptoms of lymphoma, including night sweats, weight loss, and fever. Hashimoto thyroiditis is considered a significant risk factor and the most important underlying cause of PTL. Treatment options for PTL include chemotherapy, radiotherapy, and surgery. In this study, we present a patient who exhibited airway compression symptoms and was treated via total thyroidectomy. Case Report. A 62-year-old woman presented with complaints of weakness and fatigue lasting for approximately four years. The thyroid gland appeared enlarged on inspection and firm on palpation. The patient was diagnosed with hypothyroidism, characterized by elevated autoimmune antibody levels. Ultrasound imaging revealed thyroid enlargement with parenchymal heterogeneity. Despite achieving euthyroidism through thyroid hormone replacement therapy, thyroid enlargement and ultrasound features persisted during follow-up, accompanied by ongoing complaints of neck pain and redness. On magnetic resonance imaging, the thyroid gland appeared markedly enlarged with abnormal superior and inferior extensions. Due to the rapid, diffuse growth of the goitre, the patient underwent bilateral total thyroidectomy. She was discharged on the first postoperative day after an uneventful recovery. In her postoperative first-week follow-up, she reported no complaints and was doing well. Following the histopathological diagnosis of B-cell marginal zone lymphoma, the patient was referred to the Department of Hematology, and a close follow-up was arranged. At her postoperative ninth-month follow-up, she remains asymptomatic and recurrence-free. Conclusions. Thyroid lymphoma can present with rapid growth in the thyroid gland. In addition to chemotherapy and radiotherapy, surgery may be indicated in cases with symptoms and signs of airway compression.