A 25 year old patient with no medical history showed a 5 cm basicervical anterior swelling, lateralized in the right, which appeared 4 months earlier. The swelling was associated to a mild dysphagia, without evident weight loss or infectious signs. Cervical ultrasound revealed a hypertrophy of the right thyroid lobe, with a 4 cm nodular cyst of the apex and a 1.5 nodule of the base. Biology was normal with no inflammatory signs. Thyroid function tests were normal. The patient was admitted in the ENT unit for right lobectomy. Scintigraphy and fine needle aspiration cytology (FNAC) were not performed before surgery. At the opening of the center line of the neck, we were surprised to find caseum coming from the thyroid with a necrotic destruction of the right lobe (Figure 1), frozen section was not at disposal. The right Loboisthmectomy and dissection of the recurrent nerve were very difficult. Histology showed an epithelioid and gigantocellular granulomatous process with caseous necrosis of the thyroid associated with a 1.5 cm papillary carcinoma (Figure 2).
HIV serology was negative and general check-up looking for other locations of tuberculosis revealed no abnormalities (Chest X ray, sputum analysis, abdominal ultrasound). A new surgery was performed afterward for left lobectomy. Histology revealed no tuberculous or neoplastic disease. The patient received a six-month antituberculosis regimen: 2RHZE/4RH (R:Rifampicin 10 mg/ kg/ j, H:Isoniazid 5 mg/ kg/ j, Z:Pyrazinamid 20-30 mg/ kg/j), with a satisfying uneventful evolution. No complementary anticancer treatment was necessary.