AMYLOID GOITER: A DIAGNOSTIC AND THERAPEUTIC CHALLENGE

Arafa, Sobhi; Sakr, Mahmoud; Khalil, Rafik; Abdel-Baset, Habashi; Moussa, Mohamed; El-Sharaky, Magdi; Khedr, Mahrousa

doi:10.21608/ejsur.2001.376384

AMYLOID GOITER: A DIAGNOSTIC AND THERAPEUTIC CHALLENGE

Document Type : Original Article

Authors

¹ Departments of Surgery, Faculty of Medicine, University of Alexandria, Egypt.

² Departments of Pathology, Faculty of Medicine, University of Alexandria, Egypt.

10.21608/ejsur.2001.376384

Abstract

Amyloid goiter is a very rare clinical entity that has to be distinguished from the more common types of goiter. In the
present study, we report seven cases of amyloid goiter, admitted to the Head and Neck Surgery Unit, Alexandria Main
University Hospital, during a three-year period (1998-2000). Six patients were female and one male. Their ages ranged
between 26 and 55 years with a mean age of 38.1 years. Four patients had dialysis-related amyloid goiter (DRAG), and three had secondary (reactionary) amyloid goiter. Rapid and progressive enlargement of the gland was a striking feature.
Clinically, all patients were euthyroid, except one was hyperthyroid. Serum levels of T3, T4 and TSH were not characteristic.
Anti-microsomal and anti-thyroglobulin antibodies were negative in all patients. Fine needle aspiration cytology (FNAC),
done for six patients, aided in the pre-operative diagnosis in three (50%). Final diagnosis rested on a positive Congo red
staining with characteristic apple-green birefringence under polarized light, and demonstration of the characteristic amyloid fibrils by transmission electron microscopic examination. Immunohistochemical staining showed the amyloid material to be of the beta-2 microglobulin (β-2 M) type in the four patients with DRAG, and of the AA type in the remaining three patients with reactionary amyloidosis. Total thyroidectomy was performed for all patients due to the diffuse nature of the gland, to alleviate pressure symptoms, and to exclude malignancy. Early evaluation of patients with rapidly progressive enlargement of the thyroid gland, with the possibility of amyloid goiter in mind, would allow proper diagnosis, and prompt and adequate surgical treatment, thus decreasing the duration of morbidity.