The Laryngoscope V C 2011 The American Laryngological, Rhinological and Otological Society, Inc. Case Report Amyloid Goiter: A Case of Primary Thyroid Amyloid Disease Yatin Sethi, MS; Achal Gulati, MS; Ishwar Singh, MS; Seema Rao, MD; Neha Singh, MD Amyloid goiter is an atypical presentation of an already rare disease, amyloidosis, which uncommonly comes across in previous review of literature. A patient presented with respiratory distress, which aroused a dilemma on diagnosis because the presentation mimicked that of malignancy. A high index of attentiveness should be kept whenever amyloid deposits are seen on fine needle aspiration cytology, as they are also established in medullary carcinoma. Amyloid deposits have been traced in goiter; however, it was astonishing to observe this condition causing a rapidly growing goiter, large enough to cause respiratory distress. The confirmative diagnosis rested on the histopathology of the specimen. Key Words: Amyloidosis, thyroid, goiter. Laryngoscope, 121:961–964, 2011 INTRODUCTION Amyloid goiter is defined as the presence of amyloid within the thyroid gland in such quantities as to produce a clinically apparent enlargement of the gland. Deposi- tion of amyloid in the thyroid gland occurs in 15% and 20% of cases of secondary and primary amyloidosis, respectively. 1 The deposition of amyloid in medullary thyroid carcinoma is well recognized, but the occurrence of amyloid goiter is rare, limited to just a few case reports. It is characterized by rapid growth of the thy- roid, producing pressure symptoms, but generally patients are euthyroid. Definite histopathologic diagno- sis is generally possible only postoperatively, but a high index of suspicion should be maintained whenever amyloid deposits are seen on needle aspiration cytology, which warrants a detailed workup. Surgical intervention is needed to relieve the pressure symptoms. We are pre- senting a rare case of primary thyroid amyloidosis who presented to us with an immense thyroid swelling and pressure symptoms and was successfully managed. CASE HISTORY A 46-year-old male patient presented to the otolar- yngology outpatient department with complaints of swelling in front of the neck for the past five years but that had grown rapidly in the last six months so as to cause respiratory difficulty. The patient also complained of dysphagia for the last five months. Dysphagia was progressively increasing in five months, and the patient was able to take only semisolid and liquid diet. The patient also reported a change in voice that was insidi- ous in onset and gradually worsened over two months. There was no history of vocal abuse, smoking, or diurnal variation. There were no symptoms suggestive of hypo- or hyperthyroidism. On physical examination, there was approximately 13 cm  12 cm swelling symmetrically involving both thyroid lobes and involving almost the whole front of the neck, extending beyond the sternocleidomastoids of ei- ther side. Swelling was reaching superiorly up to the angle of the mandible and inferiorly up to the clavicles. Overlying skin was normal, surface smooth, and swel- ling was firm soft to firm on palpation. Swelling moved with deglutition but not with protrusion of tongue. There were no visible pulsations or audible bruit (Fig. 1). The patient presented in inspiratory stridor, and low tracheostomy was done, cutting through part of the thy- roid isthmus. A small biopsy taken at the same time was sent for histopathologic examination, which revealed large areas of amyloid deposits. A contrast-enhanced computed tomographic scan of the neck and chest showed diffuse and multinodular enlargement of both lobes of the thyroid gland with het- erogenous attenuation and enhancement, superiorly extending up to the angle of the mandible and inferiorly just up to the suprasternal notch. There was marked compression of the trachea and lateral displacement of the carotid vessels (Fig. 2). Laboratory Investigations Thyroid function tests showed the patient to be hyperthyroid, so he was subsequently started on From the Department of Otorhinolaryngology and Head and Neck Surgery (Y .S., A.G. I.S.) and Department of Pathology (S.R., N.S.), Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. Editor’s Note: This Manuscript was accepted for publication Octo- ber 27, 2011. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Dr. Yatin Sethi, H-132, Ashok Vihar, Phase-1, Delhi, India 110052. E-mail: dryatinsethi@yahoo.co.in DOI: 10.1002/lary.21459 Laryngoscope 121: May 2011 Sethi et al.: Amyloid Goiter 961