PMC5926490_01
Axial computed tomography showing diffuse infiltrate with no precise boundaries around the thyroid.
CRIE2018-4101323.001.jpg
PMC5926490_01_CRIE2018-4101323.001.jpg
fig1
The CT scan confirmed a large thyroid lesion with esophageal invasion and decreased tracheal lumen of about 50% (Figure 1).
Increase of the anterior cervical volume during 4 months of evolution. Note the weight loss.
CRIE2018-4101323.002.jpg
PMC5926490_01_CRIE2018-4101323.002.jpg
fig2
The dysphagia and dyspnea worsened progressively and the weight loss reached 21 Kg in 6 months after the first symptoms, so she needed a surgical approach for diagnosis and treatment (Figure 2).
Intraoperative aspect of the tracheal decompression under an intense fibrotic thyroiditis.
CRIE2018-4101323.003.jpg
PMC5926490_01_CRIE2018-4101323.003.jpg
fig3
The patient underwent surgical decompression of the airway (Figure 3), protection tracheotomy, and gastrostomy for nutritional intake.
Aspect 2 years after surgery.
CRIE2018-4101323.004.jpg
PMC5926490_01_CRIE2018-4101323.004.jpg
fig4
The prednisolone was discontinued after 2 years and the evolution has been excellent, nowadays only using levothyroxine (Figure 4).
Hematoxylin and eosin staining of the thyroid lesions revealed lymphoplasmacytic infiltration, severe fibrosis, and phlebitis.
CRIE2018-4101323.005.jpg
PMC5926490_01_CRIE2018-4101323.005.jpg
fig5
The hematoxylin and eosin staining of the thyroid lesions revealed lymphoplasmacytic infiltration, severe fibrosis, and phlebitis (Figure 5).
IgG4 immunostaining revealed the presence of IgG4-positive plasma cells.
CRIE2018-4101323.006.jpg
PMC5926490_01_CRIE2018-4101323.006.jpg
fig6
The IgG4 immunostaining revealed the total number of IgG4-positive plasma cells 12/HPF (Figure 6), and the IgG4/IgG ratio was 25%.