Sarcoidosis, Hashi, RA & mastoisitis - is this lymphoma?

Diagnosed with Hashi (hypo, multinodular goiter) and RA resulting from Sarcoidosis in 2000 - taking Levothroxine (levothyroxine) 0.1mg since.  A thyroid ultrasound in Aug 2009 (prev 2008) showed a NEW hypoechoic mass 2.5cm x 2.3cm x 1.5cm with gland volume of 20cm3.  Two months later u/s showed volume increase to 30cm3 with the left lobe double the right and the nodule a solid mass located centre/left of the gland 2.6 x 2.7 x 2.0 cm. A FNA biopsy in Dec 2009 reported abundant population of lymphocytes - possible Hashimoto’s!

My TSH has been/still is normal. My original diagnosis was based on low free T4 & T3 and physical symptoms and has been controlled. If the treatment for hypothyroid is Levo why are there suddenly severe changes?  The lump is now visible to the eye and still growing. I feel cold, basal temp 96, voice is hoarse, being treated for major depression. Ferritin level is 21. Vitamin D was 0.1 in Sep but have been taking 1000 iu/day since. I am exhausted and have been suffering drenching cold night sweats despite estrogen for several years.  I have difficulty swallowing and frequently choke.  An MRI was done for concentration, memory problems & dizziness. It says I have possible mastoiditis because of a T2 hyperintensity in the right mastoid air cells – but I haven’t had a cold or earache in years! Also suffer dry crusty eyes and occasional swollen parotids & submandulars.

Mother died of tonsillar cancer at my age (55). I am concerned about possible thyroid lymphoma despite my doctors telling me her cancer is no way related. She smoked I quit 1989.  Internist has just closed his file because of the reports, but I am convinced that this is all related.  My fear is that a doctor will discover down the road that I was right but once it’s too late to do anything.  I am also afraid that this may be genetic because I have 4 grown children – 2 of which show autoimmune symptoms already.  My doctor laughed at me. Your opinion is greatly appreciated!

[Garth L Nicolson, PhD]

Your physician should not have laughed at you, because some patients with similar problems to what you have described have had thyroiditis caused by an infection of the thyroid gland.  This could result in cysts or other concentrations of lymphoid cells that could show irregularities on imaging.  Swollen lymph nodes and other problems could also go along with this situation.  Thyroiditis can be misleading because some patients exhibit low levels of thyroid hormones (the most common finding), some high and some patients do not show levels out of normal range.  

On the other hand, if there is anything that could be a tissue mass, such as a benign lesion (which could progress under the right circumstances and genetic background), a biopsy could be taken to confirm or not this possibility.