Lymph Nodes Close to the Thyroid Isthmus Can Masquerade as Malignant Thyroid Nodules in Chronic Lymphocytic Thyroiditis

We present a 40 year old lady who was previously reviewed in a different center with a neck swelling and a clinical and biochemical picture of post-partum thyroiditis. She underwent a fineneedle aspiration (FNA) biopsy of a hypoechoic isthmus nodule that was reported as being a follicular neoplasm and diagnostic surgery was recommended. She presented to ourselves for a second opinion. She had clinically improved by this time and on re-do sonography was found to have multiple lymph nodes in close proximity to the isthmus and prominent appearances of thyroiditis, but no suspicious thyroid nodules per se. Follow-up ultrasonography revealed unchanged appearances and on review at the regional thyroid nodule and cancer multi-disciplinary meeting an unanimous consensus was reached that no invasive procedures or treatments were indicated apart from clinical and sonographic monitoring. The likely original course of events is that the small lymph nodes in close association to the thyroid isthmus were mistaken for thyroid nodules and the subsequent FNA picked up some thyroid material from areas of active inflammation and that is why it was reported as being consistent with a follicular neoplasm. The main focus of this study is to emphasize to all practitioners that deal with thyroid disease that reactive lymph nodes in chronic lymphocytic thyroiditis can sometimes be confused with thyroid nodules because of their close proximity with the thyroid gland.