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Lymph nodes in the neck - Case 8.

A patient previously treated for Hodgkin's disease

Nodular goiter

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Clinical data: a 24-year-old woman was referred for evaluation of a suspected thyroid disease. She was treated for Hodgkin's disease localized to both sides of the neck for 3 years. After chemotherapy and external irradiation to the neck she was in remission for 18 months. The enlarged lymph nodes in both sides of the neck were gradually decreased. She became pregnant and on ultrasonography a hypoechogenic thyroid was detected. She had no complaints. We investigated her on 8th gestational week.

Palpation: no abnormality in the thyroid. There were multiple, moderately firm lymph nodes in both sides of the neck.

Laboratory investigation resulted in euthyroidism: TSH 1.98 mIU/L, FT4 13.9 pM/l, aTPO 2 U/mL, anti-hTg 0 U/mL.

Ultrasonography: the thyroid was moderately hypoechogenic. There were multiple enlarged lymph nodes in both sides of the neck. They presented regular hilum.

We advised regular follow-up. TSH determination every 2 months during pregnancy and thereafter every year. She delivered a healthy girl and was euthyroid 15 months after delivery when the last TSH was performed.

Comment. We cannot decide whether this patient has an autoimmune thyroiditis or the hypoechogenicity is explained by the previous irradiation. Nevertheless, the differential diagnostic has minimal if any consequence because the patient had to be followed lifelong.

 

 


 

 

 

 

 

 

 

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