[Progressive thyroid lymphocytic infiltration in a patient with chronic hepatitis].

We report the case of a 53-year-old woman with a personal history of chronic venous insufficiency and recurrent biliary colic who was seen after goiter was detected at during routine medical visit. A physical examination revealed diffuse grade 3 goiter associated with two to four bilateral hard nodules attached to deep planes. There were no adenopathies. No thyroid tenderness or other findings were made during the physical examination. Laboratory test results included: liver enzymes: GOT, 69 IU/L; GPT, 53 UI/L; GGT, 360 IU/L; AP, 2429 IU/L. Thyroid hormones: TSH, 4.16 U/mL; FT4, 1.07 ng/dL. Anti-thyroid antibodies (anti-thyroglobulin and anti-thyroperoxidase): negative. Acute phase reactants: Creactive protein, 33.5 mg/L; ESR: 73 mm/h. Thyroid ultrasound examination: four solid, hypoechoic, non-vascularized nodules 2--5 cm in size were seen, two in each nodule. The predominant nodule, 5 cm in size, was found in the middle portion of the right lobe. Fine needle aspiration: puncture of the dominant nodule was inadequate for cytological study. The patient was therefore referred for endocrine surgery because of nodule size. During surgery, a mass of a woody consistency was found, closely adherent to adjacent tissues, which prevented complete resection. Pathological study of surgical specimen. Gross examination: left lobe: brown whitish triangular fragment 1.5 cm in size of elastic consistency, with no normal thyroid tissue upon sectioning. Right lobe: triangular fragment 1.5 cm in size with similar characteristics to the left fragment. Immunohistochemistry: CD-3 and CD-20: positive scattered lymphoid infiltrate. Kappa and lambda light chains: positive in plasmacellular infiltrate. Cytokeratin pan: negative. Thyroglobulin: positivity for vestiges of thyroid follicles. Microscopic examination: sections showed thyroid tissue in both lobes to be widely replaced by collagenized fibrous tissue, marked thyroid follicle atrophy, and marked infiltration of mononuclear