Associate Professor in Medicine Mayo Clinic Rochester, Minnesota, United States
Disclosure(s):
Ewelina Niedzialkowska, MD: No financial relationships to disclose
Introduction: Thyroid lymphoma (TL) is a rare clinical entity that poses significant diagnostic challenges. It accounts for approximately 1–5% of all thyroid malignancies. While rare, it has a rapid progression with possible significant tracheo-esohageal compression. Diagnosis is often delayed due to inadequate tissue sampling, as fine-needle aspiration biopsy (FNA) frequently yields insufficient material for immunohistochemical analysis. As such, core needle biopsy demonstrates higher sensitivity for a definitive diagnosis.
Methods: We retrospectively reviewed 10 cases of biopsy-proven thyroid lymphoma diagnosed at our institution between 2013 and 2025. Demographic data, clinical presentation, imaging findings, histopathology, and diagnostic methods were analyzed.
Results: The median age at diagnosis was 69 years, with equal sex distribution (5 females, 5 males). Six patients (60%) had a prior history of Hashimoto’s thyroiditis. The median duration of symptoms prior to diagnosis was 5.6 months. The most common presenting symptom was a rapidly enlarging thyroid mass (70%), followed by dysphagia (40%), hoarseness (20%), and weight loss (10%). Histopathologic subtypes included diffuse large B-cell lymphoma (DLBCL) in five patients, mucosa-associated lymphoid tissue (MALT) lymphoma in two, T-cell lymphoma in one, chronic lymphocytic leukemia in one, and Hodgkin lymphoma in one. Nine patients had primary thyroid lymphoma, while one had secondary thyroid involvement. Ultrasound findings demonstrated diffuse thyroid enlargement in 40% of cases, large focal thyroid masses in 40%, cervical lymphadenopathy in 40%, and features consistent with chronic thyroiditis in 10%. Final diagnosis was established by fine-needle aspiration in 10% of cases, core needle biopsy in 30%, thyroidectomy in 30%, and excisional biopsy in 20%. Eight patients received combination chemotherapy, 1 patient was treated with radiation therapy alone, and 1 patient underwent radiation therapy in combination with thyroidectomy. During follow-up, 5 patients achieved remission, 3 experienced disease recurrence, 1 transitioned to hospice care, and 1 patient is awaiting initiation of therapy.
Conclusion: Thyroid lymphoma predominantly affects older adults and is frequently associated with Hashimoto’s thyroiditis. Rapid thyroid enlargement with compressive symptoms should raise clinical suspicion. While ultrasound findings are variable, definitive diagnosis often requires tissue analysis beyond the FNA sample. Early recognition is essential to guide appropriate and timely management and avoid unnecessary surgery.
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