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KMID : 0371319680100060441
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Journal of the Korean Surgical Society
1968 Volume.10 No. 6 p.441 ~ p.444
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Tuberculosis of the Thyroid Gland
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趙列河/Cho, Yul Ha
康相均/金喆淳/羅燾憲/Kang, Sang Kyoon/Kim, Cheul Sun/Rah, Doh Hun
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Abstract
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The incidence of tuberculosis of the thyroid gland is very low and it is extremely rare. The rarity of occurrence may be appreciated from the figures collated at the Mayo Clinic where 20,758 thyroid glands were removed surgically during an 11 year period (1920-1931) and tuberculosis was diagnosed twenty-one times, an incidence of 0.1%. We believe that the case to be reported is the first to be treated with surgical intervention in Korea.
The patient was 37 year old housewife who had been well until 2 years prior to admission, when she developed swelling in the right side of the neck. During 2 months prior to admission the swelling had increased fairly rapid growth to the size of a large hen´s egg in association with dysphagia, intermittent fever with headache, fine tremor in both hands and palpitation with nervousness but there had been no dyspnea or exophthalmos.
Systemic review revealed anorexia, a weight loss of unknowna mount, heavy sweat at night as well as fever of unknown degree, especially since the past 2 months of illness.
Family history was noted that her husband had been in good health, but was otherwise non-contributory about her tuberculosis backgrownds. she denied the history of tuberculous disease in her past history.
On physical examination the patient revealed a mass, well difined, with a smooth surface occupying clinically the entire right lobe of the thyroid, and remarkably fluctuation for a thyroid cyst, otherwise partly hard for a thyroid adenoma moving with deglutination. There was no history of sign of pressure effect, no Horner´s syndrome or paralysis of the vocal cords except dysphagia. The remainder of the physical examination was within normal limits.
The hemoglobin was 9.7g %, hematocrit 34%, sedimentation rate 45 mm, cholesterol 118mg%. The serum electrolytes disclosed within normal limits including calcium and phosphorus. A routine chest X-ray showed irregular infiltration and bronchiectatic changes with spotty calcification in the right upper lung field and some calcification and streaky infiltration in the left upper lung field. BMR was＋5%. The sputum examination of direct smear and culture for acid-fast bacilli was once negative.
At operation, the thyroid was explored and the right, total hemithyroidectomy was performed. The pathology reported as a tuberculosis of the thyroid gland, active, with large cavitary lesion and on special staining, many acid-fast bacilli were demonstrable, but no evidence of malignancy. This patient was discharged on the 7 th post-operative day with anti-tuberculous drugs.
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