Delayed recognition of primary thyroid lymphoma with progressive thyroid enlargement and cardiopulmonary symptoms.
- 1Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA.
- 2Division of Hematology and Oncology, Department of Medicine, ProMedica Health System, Toledo, OH 43606, USA.
- 3Department of Pathology, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA.
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.
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BibTeX
@article{tovar2026delayed,
title = {{Delayed recognition of primary thyroid lymphoma with progressive thyroid enlargement and cardiopulmonary symptoms.}},
author = {Yara E Tovar and Ahmed G Elsayed and Manali Pragani and Paul T Romanoski and Ravleen Kaur and John Y Jun},
journal = {JCEM case reports},
year = {2026},
month = nov,
doi = {10.1210/jcemcr/luag339},
url = {https://europepmc.org/article/MED/42996579},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Delayed recognition of primary thyroid lymphoma with progressive thyroid enlargement and cardiopulmonary symptoms.
AU - Yara E Tovar
AU - Ahmed G Elsayed
AU - Manali Pragani
AU - Paul T Romanoski
AU - Ravleen Kaur
AU - John Y Jun
PY - 2026
DA - 2026/11/06
JO - JCEM case reports
DO - 10.1210/jcemcr/luag339
UR - https://europepmc.org/article/MED/42996579
AB - 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.
SN - 2755-1520
ER -