Delayed recognition of primary thyroid lymphoma with progressive thyroid enlargement and cardiopulmonary symptoms
Year: 2026
Type: article
Study design: Case Report
Abstract: Primary thyroid lymphoma (PTL) is a rare thyroid malignancy that may present with respiratory symptoms overlapping with cardiopulmonary disease, contributing to delayed diagnosis. We report a 78-year-old woman with chronic lymphocytic thyroiditis, chronic obstructive pulmonary disease, heart failure, and prior lung cancer whose worsening dyspnea was repeatedly attributed to underlying cardiopulmonary conditions. She subsequently developed dysphonia and dysphagia with a rapidly enlarging thyroid mass requiring tracheostomy for airway protection. Prior computed tomography imaging obtained during multiple evaluations for cardiopulmonary symptoms incidentally demonstrated subtle thyroid enlargement with progressive interval growth on retrospective review. Core biopsy confirmed diffuse large B-cell lymphoma, and staging established stage IIIE disease. Given her age and comorbidities, a dose-reduced regimen of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone was initiated. Despite treatment, her condition deteriorated rapidly, and she died shortly thereafter. This case underscores how overlapping comorbidities can obscure PTL presentation until advanced airway compromise develops. In patients with persistent respiratory symptoms despite appropriate cardiopulmonary management, careful review of prior imaging is critical because subtle thyroid enlargement may otherwise be overlooked.
Source: JCEM Case Reports
Institutions: University of Toledo, ProMedica
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $930
OpenAlex ID: W7225380345