Not just a goiter: Uncovering primary thyroid lymphoma

Primary thyroid lymphoma (PTL) is a rare, aggressive neoplasm of the thyroid gland that occurs most frequently in older women. We describe a 60-year-old woman who presented to our hospital with a primarily painless, progressively enlarging neck swelling over the previous four months. Imaging showed an enlarged thyroid gland and mass effect in the surrounding neck soft tissue. Fine needle aspiration revealed a predominance of lymphoid cells to suggest that this hypothesized mass was a thyroid neoplasm. Biopsy of the thyroid gland confirmed non-Hodgkin lymphoma of the thyroid. She was treated with standard CHOP chemotherapy. This case highlights the conundrum of PTL in a rapidly enlarging mass of the thyroid gland and the need to address this early with better diagnosis and therapeutic plan.