Rare case of Rheumatoid nodules in thyroid gland parenchyma: a report

Dr Efthimios Sivridis at Department of Pathology, Democritus University of Thrace Medical School and University General Hospital of Alexandroupolis, Greece and colleagues have reported a rare case of rheumatoid nodules in thyroid gland parenchyma. The case has appeared in the Journal of Medical Case Reports.

The rheumatoid nodule is the most common extra-articular manifestation of rheumatoid arthritis. When present, it is readily identified in conventional hematoxylin and eosin sections.

A 33-year-old Greek woman was found to have hypothyroidism following a thorough investigation of migraines, after a road traffic accident. The event was complicated with craniocerebral injury necessitating tracheostomy. Her past medical history included RA of 3-year duration treated with methotrexate (2.5 mg three times per day), and topiramate medication for migraines (200 mg twice a day). On clinical examination, the thyroid gland was painless and not palpable. Laboratory tests confirmed a positive rheumatoid factor (RF) with normal antithyroglobulin (anti-TG) and thyroid peroxidase antibodies (anti-TPO) (16 U/ml and 16.7 U/ml, respectively). An ultrasound-guided fine needle aspiration biopsy performed in a private clinic showed distinct nodules in the lower pole of the left thyroid lobe, which were reported as being suggestive, though not conclusive, of malignancy (category V Bethesda) [12]. She was put on thyroxine (T4) treatment and when she became euthyroid with thyroid-stimulating hormone (TSH) of 0.89 μIU/ml, triiodothyronine (T3) of 1.30 ng/mL, and T4 of 7.2 μg/dl, she was subjected to a total thyroidectomy in our hospital.