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Infiltrative thyroid disease

Stephanie L Lee, MD, PhD
Sonia Ananthakrishnan, MD
Section Editor
Douglas S Ross, MD
Deputy Editor
Jean E Mulder, MD


Infiltration of the thyroid may occur as an isolated abnormality or as a manifestation of generalized disease. The infiltration usually presents as progressive thyroid enlargement that is painless, firm, and bilateral, and may be confused with goitrous autoimmune thyroiditis (Hashimoto's thyroiditis), nontoxic multinodular goiter, subacute thyroiditis, infectious thyroiditis or occasionally thyroid cancer or lymphoma. (See "Clinical presentation and evaluation of goiter in adults" and "Overview of thyroiditis" and "Pathogenesis of Hashimoto's thyroiditis (chronic autoimmune thyroiditis)" and "Diagnostic approach to and treatment of thyroid nodules" and "Thyroid lymphoma".)

The clinical course and pathologic findings of the most common forms of infiltrative thyroid disease, excluding those of autoimmune, infectious or malignant origin, are reviewed here. Most of these diseases involve other organs, but the focus here will be on the thyroid manifestations.


Infiltrative thyroid diseases are rare. Painless, progressive enlargement of the thyroid is the most common presentation of infiltrative thyroid disease. Changes in thyroid function tests are less commonly seen, although infiltration of the thyroid can be associated with hypothyroidism.

We routinely measure thyroid function tests (thyroid-stimulating hormone [TSH] and free thyroxine [T4]) when thyroid enlargement or nodular thyroid disease is noted on physical examination. Many thyroid experts also check serum thyroid peroxidase (TPO) antibodies in patients with diffuse thyroid enlargement (regardless of the TSH level) to confirm the diagnosis of chronic thyroiditis. (See "Clinical presentation and evaluation of goiter in adults", section on 'Approach to evaluation' and "Diagnostic approach to and treatment of thyroid nodules", section on 'Evaluation'.)

We perform thyroid ultrasonography to assess the morphology of the thyroid gland when infiltration is suspected. Fine-needle aspiration (FNA) of a suspicious nodule or expanding mass in the thyroid may be considered to further evaluate the variable pathology of this entity. The presence of a high titer of TPO antibodies does not negate the need for FNA biopsy of a thyroid nodule or expanding mass in patient with Hashimoto’s.


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Literature review current through: Sep 2016. | This topic last updated: Mar 31, 2016.
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