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Systemic light-chain amyloidosis incidentally diagnosed after subtotal parathyroidectomy and thyroid lobectomy
  1. Karen Tsai1,2,
  2. Alice Chen Yu3,
  3. Masha J Livhits4,
  4. Dipti Sajed5,
  5. Angela M Leung1,2 and
  6. Dianne S Cheung1
  1. 1Division of Endocrinology, Diabetes, and Metabolism, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
  2. 2Division of Endocrinology, Diabetes, and Metabolism, UCLA David Geffen School of Medicine, Los Angeles, California, USA
  3. 3Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
  4. 4Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, USA, Los Angeles, California, USA
  5. 5Department of Pathology and Laboratory Medicine, UCLA Geffen School of Medicine, Los Angeles, California, USA
  1. Correspondence to Dr Karen Tsai; karentsai{at}mednet.ucla.edu

Abstract

A 74-year-old woman with a history of primary hyperparathyroidism, thyroid nodules, atrial fibrillation and pacemaker placement for sick sinus syndrome presented with fatigue, constipation and persistent lower extremity oedema. She underwent subtotal parathyroidectomy and left thyroid lobectomy. Histopathology revealed amyloidosis affecting the thyroidand parathyroids confirmed by Congo Red Staining with Mayo Clinic subtyping of light chain kappa-type amyloidosis. She was found to have combined systolic and diastolic cardiac dysfunction, carpal tunnel neuropathy and pre-diabetes suggestive of systemic amyloidosis with involvement of the heart, nerves and pancreas. Congo red stain was positive for amyloidosis on bone marrow biopsy suggestive of a diagnosis of systemic amyloidosis. She was treated with daratumumab with good clinical response. This case illustrates the necessity of considering systemic amyloidosis in patients with incidentally discovered diffuse amyloid deposits on biopsy of an endocrine organ, as endocrine effects are a rare but likely underdiagnosed consequence of systemic amyloidosis.

  • calcium and bone
  • pathology
  • head and neck surgery
  • medical management
  • haematology (incl blood transfusion)

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Footnotes

  • Contributors KT, ACY, ML, AL, DS and DC all meet authorship criteria and are listed as authors. KT, ACY, ML, AL, DC and DS all certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing or revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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