The thyroid may be affected primarily or secondary to lymphoma elsewhere. This article is concerned with primary thyroid lymphoma.
Thyroid lymphoma accounts for <5% of thyroid malignancies and ~2.5% of extranodal lymphoma.
Thyroid lymphoma is rare with an incidence of 1-2 per 1,000,000. It typically presents between 50-70 years of age with a strong female predominance (M: F = 1:3).
Typically, it presents as a rapidly enlarging goiter with compressive symptoms and cervical lymphadenopathy common. B-type symptoms are uncommon (20%) and approximately half of patients are euthyroid.
The etiology of thyroid lymphoma is unclear. Hashimoto thyroiditis is a major risk factor (~60 times increased risk) but development of thyroid lymphoma is still rare in this group.
The histological subtype of thyroid lymphoma is heterogeneous with diffuse large B cell lymphoma being the most common in one series 2.
The radiographic features of thyroid lymphoma are nonspecific and similar to other primary thyroid malignancies and Hashimoto thyroiditis.
Three patterns have been described: nodular (hypoechoic mass), diffuse (mixed echotexture), or mixed 1,3. Calcifications are uncommon 4.
- goiter, which is hypodense to adjacent muscle
- heterogeneous enhancement but still less than adjacent muscle 3
- T1/T2: iso- to hyperintense
- pseudocapsule may be present 3
Treatment and prognosis
Prognosis is generally considered "excellent" for disease limited to the thyroid. Combination chemotherapy and radiation therapy is generally used with surgical excision less common 1,2,4.
- 1. Walsh S, Lowery AJ, Evoy D et-al. Thyroid lymphoma: recent advances in diagnosis and optimal management strategies. Oncologist. 2013;18 (9): 994-1003. doi:10.1634/theoncologist.2013-0036 - Free text at pubmed - Pubmed citation
- 2. Thieblemont C, Mayer A, Dumontet C et-al. Primary thyroid lymphoma is a heterogeneous disease. J. Clin. Endocrinol. Metab. 2002;87 (1): 105-11. doi:10.1210/jcem.87.1.8156 - Pubmed citation
- 3. Wang JH, Chen L, Ren K. Identification of primary thyroid lymphoma with medical imaging: A case report and review of the literature. Oncol Lett. 2014;8 (6): 2505-2508. doi:10.3892/ol.2014.2542 - Free text at pubmed - Pubmed citation
- 4. Xia Y, Wang L, Jiang Y et-al. Sonographic appearance of primary thyroid lymphoma-preliminary experience. PLoS ONE. 2014;9 (12): e114080. doi:10.1371/journal.pone.0114080 - Free text at pubmed - Pubmed citation
- 5. Schneider DF, Chen H. New developments in the diagnosis and treatment of thyroid cancer. CA Cancer J Clin. 2013;63 (6): 374-94. doi:10.3322/caac.21195 - Free text at pubmed - Pubmed citation
Related Radiopaedia articles
- thyroid inflammatory disease
- thyroid neoplasm
- thyroid nodules
assessment of thyroid lesions
- incidental thyroid nodules
ultrasound assessment of thyroid lesions
- American Thyroid Association (ATA) guidelines
- British Thyroid Association (BTA) U classification
- McGill thyroid nodule score
- Society of Radiologists in Ultrasound (SRU) guidelines
- postoperative assessment after thyroid cancer surgery
- ultrasound-guided fine needle aspiration of the thyroid
- assessment of thyroid lesions
- overview of lymphoma
WHO classification of tumors of hematopoietic and lymphoid tissues
- Hodgkin lymphoma
- mature B-cell lymphoma
- mature T-cell and NK-cell lymphoma
- post-transplant lymphoproliferative/lymphoproliferation disorders
- location-specific lymphomas
- central nervous system
- head and neck lymphoma
- thoracic lymphoma
- gastrointestinal lymphoma
- hepatobiliary lymphoma
- genitourinary lymphoma
- musculoskeletal lymphoma
- cutaneous lymphoma
- lymphoma staging