Rheumatoid Nodules in Thyroid Gland Parenchyma as an Expression of Rheumatoid Arthritis

A Case Report

Efthimios Sivridis; Maria Kouroupi; Michael Ioannis Koukourakis; Stella Arelaki; Nikolaos Lyratzopoulos; Alexandra Giatromanolaki

Disclosures

J Med Case Reports. 2019;13(159) 

In This Article

Background

Rheumatoid arthritis (RA) is a systemic inflammatory disease of an autoimmune nature, occurring in 0.5–1% of the population.[1,2] Women are affected two to three times more commonly than men. The condition involves symmetrically the peripheral synovial joints – hands, feet, and wrists – particularly over bony prominences, leading to articular destruction and disability.[1] Extra-articular manifestations of RA occur in more than 35% of patients[3,4] and are associated with severe active disease and a decreased survival rate.[3] Tissues that can be affected include extra-articular structures, such as tendons, ligaments, or fascia[3] and other organs, including skin,[5] lungs,[6] oral mucosa,[7,8] gastrointestinal tract,[8] and cardiovascular[9] and neurological systems.[10]

In all extra-articular sites, the characteristic pathological finding has been the rheumatoid nodule – solitary or multiple nodules, 0.2 to 5 cm or more in diameter – containing areas of fibrinoid necrosis surrounded by palisading histiocytes.[6,11] To the best of our knowledge, such nodules have not previously been described in the thyroid gland parenchyma.

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