Primary tuberculosis of the thyroid gland: an unexpected cause of thyrotoxicosis

Primary tuberculosis of the thyroid gland: an unexpected cause of thyrotoxicosis

Tuberculosis has often been implicated as a cause of specific organ disease - classic example being Addison's disease which was originally identified as tuberculosis of the adrenal glands. Tuberculosis of the thyroid is also documented - but not very often in recent years, in Europe and north America. (I suspect it is more common in those countries where tuberculosis itself is more prevalent.)

BMJ Case Rep. 2014 Feb 27;2014. pii: bcr2013202792. doi: 10.1136/bcr-2013-202792.

Primary tuberculosis of the thyroid gland: an unexpected cause of thyrotoxicosis.

Raman L1, Murray J, Banka R.

Author information

Department of Respiratory, King George Hospital, London, UK.

Abstract

We describe a 38-year-old Indian man who presented with a 2-week history of fever, night sweats and neck swelling who was found to be clinically thyrotoxic with a nodular goitre, tachycardia and high fever. Biochemical investigation revealed hyperthyroidism in association with deranged liver function tests and raised inflammatory markers. Ultrasound and CT scans of the neck revealed multinodular thyroid enlargement. He was considered most likely to have an acute infectious thyroiditis with a differential diagnosis of a toxic multinodular goitre and was started on carbimazole and antibiotics. He underwent fine needle aspiration of the thyroid which revealed necrotic cells and acid-fast bacilli, confirming a diagnosis of primary tuberculosis (TB) of the thyroid gland with no evidence of any other organ involvement on systemic imaging. He was started on TB therapy for 6 months and discharged with outpatient follow-up. Symptoms and biochemical markers subsequently resolved.

PMID:

24577178

[PubMed - in process]

ncbi.nlm.nih.gov/pubmed/245...

And other reports here:

omicsgroup.org/journals/216...

omicsonline.org/tuberculosi...

Rod

23 Replies

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  • TB is sadly on the increase (I doubt they have badgers in India?)

    Years ago 'consumption' was 'cured' here by sunlight & fresh air - and a pioneering hospital founded nearby for this cause. Then eradicated by antibiotics.

    This is a just a site supporting Thyroid problems - but nothing/no-one is excluded - it never ceases to amaze me how we investigate & discuss all possibilities - it surely is a complicated, susceptible yet vital little gland! J :D

  • Hardly a vital little gland, Jane. Some of us don't have one. It's no problem though, we just have to take a little white pill every day... >>>>>>> I'll get me coat >>>>

  • As we know TB is linked to LOW VitD. I think I am that person. My result yesterday confirmed I am still struggling to raise the level. Could be the reason I succumbed to gut TB 50 years ago.... Thank you for the post Rod - don't think I have a TB thyroid - but of course you never know... :-)

  • Very interesting about the link with Vit D, I didn't know that.

  • There is at least speculation that this is could be why the harsh conditions in some TB sanatoriums worked - the patients were forced to be as exposed to the sun as possible. Of course, there could be numerous other factors as well.

    Rod

  • Yes, I think low Vit D leaves us susceptible to all sorts! - just read your root cause link & am wary of vaccinations too, (although aluminium is now used instead of mercury - so my daughter informs me)

    Meanwhile an extract from our local hospital's archives.....

    "By 1901 there were 20 patients, some of whom found it difficult to navigate the steep staircase to the wards. The decision was therefore made to build a shed, open on one side, in the garden to house the children unable to walk, as the benefits of fresh air and sunshine were well-known. In this way the principle of openair treatment was established."

    see - you are in the right place Marz (you knew this already!) J :D

  • ....not sure what brought us here - think it had to do more with retirement and how we could create an income ! We were not sorted ! By selling a flat in the UK we were able to build a house and another to let - problem solved :-) Inadvertently it was the right place for healing and sorting with an excellent medical system that actually looked at the whole body...and thorough testing.

    Isn't aluminium one of the nasties too I have read....don't ever cook rhubarb in an aluminium saucepan .... :-)

    I once spent several weeks in an old TB sanatorium on the outskirts of Bristol - Ham Green. More of a terminal unit - or where they put you when they didn't know what to do with you. Albeit I was starting my TB treatment and feeling horrendous. I think it was those drugs that I took for well over a year that compromised my gut and sent me on the road to Hashimotos et al.... back in 1973. Took me another 20 or so years to recover....

    Oh well - yoga class tomorrow - so onwards and upwards....

    Thanks spareribs for your post.... :-)

  • Hi, do you think that there could perhaps be a link with TB immunisation? Thanks.

  • Thank you. Last year we thought our daughter had glandular fever but the test was negative. Now, a year later we have been told she has hyperthyroidism and am seeing the doctor tomorrow. She was the only one in her year to be given the TB vaccine as her grandfather was Indian.

  • In my day - back in the late 50's - we were all tested with the circle of needles and if there was no reaction - then we were immunised. Hope all goes well with the Doctor tomorrow and that your daughter soon feels well.

  • thanks

  • Way back in 1974 I taught a little boy who was found to have TB in a gland in his neck. That was when I discovered that TB can pop up pretty much anywhere in the body. Wonder if he had what is mentioned here? And yes, TB is much more ore leant these days, 20 or so years later I taught a little girl who also had it, and the mother of one of my sons friends had it too. In the late 1970s my children were born in the Glasgow area and my health board was still routinely vaccinating against TB but my sister in law had to ask for my nephew and niece who lived not that far away from us to be vaccinated.

  • TB glands can be serious as the infection can spread to the brain. This happened to my brother who sadly died of Meningitis at 9 - TB meningitis. Now he would be 75....and hopefully still playing the piano !

  • Poor little boy and poor family to lose him. It is strange how people tend to think of it as always being in the chest. People can be very casual about it, way back in 74 that first child's classmates were not checked out when it was discovered ( I was young and naive then) but I remember absolutely insisting that someone come out and do tests on all the kids in my class when the little girl had it - my head teacher thought I was being very unreasonable about it but none of the children had been vaccinated against it at that time, fortunately they were all ok as was the little girl who had it and her family - her father had it too.

  • ..we learn with age. I often think how fortunate the younger people are on this forum and others - that they have such good information at their finger-tips. Literally... :-)

  • Hi something for the mix...lots going on in my glands and down below ,11 months in , I'm glad to report I DONT have herpes virus ( 1 or 2 ) and I don't have Behçet's disease as my Gp thought ( it all takes so long between referral and appointments.) But to get back to the point, it's all happening in my below regions and throat. the Gynae has referred me to the dermatologist..( and also wants to do laparoscopy and biopsies and investigation under anesthetic ) they think Lichen Planus.... or there's a number of other lichens! Or something autoimmune going on! ( I wasn't surprised. !)

    So I went to the herbalist friend who helps ( you need help when your passed from pillar to post and your in pain and sore with no diagnoses , there's no help) so she says ,Lichen Planus ...caused by TB!, I read about it in her books ..no where does it say Autoimmune.... ( although all I have read on the Internet would say autoimmune ) .

    I live in a inner london borough where TB is rife..my friend worked for the local health authority and her job was to help run clinics and on other days do house visits..people might say they live alone or with two others but it's her job to check the numbers at the address of a patient so all can be tested and given inoculation or treatment...

    I go for my blood tests to the centre where in the waiting room area ,on one side of the aisle are people clutching a numbered ticket to give blood and on the other side of the aisle are the TB clinic patients...most mornings ... And some afternoons .

    I don't sit with the mass! I get my ticket and wait outside ..it's possible to be there for a good couple of hours...I used to worry about being where people had colds !

    I'm now the holder of the titles in Hashi's ,Lupus SLE,Sjogrens,Hughes,Fowlers syndrome, fibromyalgia (and more!) ...so I would say I'm a kind of autoimmune kind of girl ( well old girl then)... The titles roll in like buses..

    I will keep you up to date as I learn of what's going on...

  • Wow, you are an autoimmune kind of girl. Know what you mean about not wanting to sit among sick people! Hope you get a diagnosis soon.

  • This is the first time I've heard about a link between TB and vit D. Thanks for posting everyone! My grandfather died of bovine TB, his daughter (my aunt) had TV meningitis and I and several female cousins have underactive thyroids! I'm beginning to think that we have a genetic problem making vit D. Does anyone know if this exists? And is there a test for it?

    Thanks

  • ...take a look at the post by Rod - Helvella - last Sunday - about Hashimotos and Vit D - and the research taking place here in Crete. There is a genetic component.... Something to with VDR's - vitamin D receptors....If you can't find it get back to me....it was me that had the brother with TB meningitis who died at 9....

  • healthunlocked.com/thyroidu...

    It is sad about your brother, my mum was named after her auntie who died from meningitis (I wouldn't know if it was TB) it's heartbreaking when so young. J x

    My auntie, however, recovered from TB (in a 'sanatorium') I think this inspired her to be a nurse. (I apologise for my lack of correct words at present, I am having a problem with this).

  • Thank you - for the link and kind words.... M x

  • Another snippet to add:

    Indian J Tuberc. 2014 Jan;61(1):84-7.

    Thyroid tuberculosis: presenting symptom of mediastinal tuberculous lymphadenitis--an unusual case.

    Chandanwale SS, Buch AC, Vimal SS, Sachdeva P.

    Abstract

    Tuberculosis of thyroid gland is extremely rare. It spreads to thyroid by lymphogenous or heamatogenous route or from adjacent focus, either from larynx or cervical and mediastinal adenitis. We report an unusual case of a 33-year-old male with thyroid swelling. Fine needle aspiration (FNA) smears showed epithelioid cells without necrosis and acid fast bacilli (AFB). Subsequent investigation revealed mediastinal tuberculous lymphadenitis on Computerized Tomography (CT) scan. FNA confirmed the diagnosis of mediastinal tuberculous lymphadenitis. We conclude, when epithelioid cells are seen on FNA thyroid, tuberculosis must be ruled out especially in regions where there is high prevalence of tuberculosis.

    PMID: 24640351 [PubMed - in process]

    ncbi.nlm.nih.gov/pubmed/246...

    Rod

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