[Abstract] Objective To investigate the diagnosis and treatment of thyroid lymphoma. Methods Combining domestic and international literature, we retrospectively analyzed the diagnosis and treatment experience of 7 cases of thyroid lymphoma admitted to our hospital from 1998 to 2003. The clinical features of thyroid lymphoma in this group were rapidly enlarging thyroid nodules with symptoms of pressure such as breath-holding and dysphagia; some patients also had symptoms of nerve involvement such as choking on water and hoarseness. The diagnosis was confirmed by pathology and immunohistochemical examination in all cases. The treatment was mainly a combination of surgery combined with chemotherapy and radiotherapy. Conclusion Surgical resection/excision biopsy is a reliable means to diagnose thyroid lymphoma; its treatment should be a combination of surgery with chemotherapy and radiotherapy. The prognosis of thyroid lymphoma is relatively good if it is treated promptly because it is sensitive to chemotherapy and radiotherapy. This paper is a retrospective analysis of the results of our hospital since 1998. In this paper, we retrospectively analyzed 7 cases of thyroid lymphoma admitted to our hospital from 1998 to 2003, and analyzed their diagnosis and treatment experience, which are reported below. Clinical data The 7 cases of thyroid lymphoma in this group, 4 female and 3 male; age 39-71 years old, average 59 years old; clinical manifestation of thyroid enlargement, including 4 cases with breath-holding, 3 cases with hoarseness, 1 case with paraneoplastic syndrome, 1 case with hypothyroidism, 1 case with weakness and emaciation; B-US examination found thyroid enlargement, including 4 cases with diffuse enlargement and 3 cases with solid All patients were found to have enlarged thyroid gland on B-US examination, including 4 cases with diffuse enlargement and 3 cases with solid nodules. All patients showed tracheal compression and displacement on tracheal imaging. Fibrolaryngoscopy revealed paralysis of the recurrent laryngeal nerve in 3 cases. Preoperative diagnosis of nodular goiter was made in 3 cases, thyroid cancer in 2 cases, and chronic lymphocytic thyroiditis in 2 cases. All patients underwent surgical resection or excisional biopsy, and the postoperative pathology was non-Hodgkin’s lymphoma of the thyroid gland, B-cell type. Five patients were treated with CHOP chemotherapy after surgery, and four of them are still alive, the longest one has survived for 6 years, and one has been lost; one case was lost to radiotherapy. Discussion Diagnosis of thyroid lymphoma The incidence of thyroid lymphoma is low, about 1.3% to 2.5% [1]. In our hospital, 308 cases of thyroid cancer were admitted during the same period, accounting for about 2.3%. The literature reports that thyroid lymphoma lacks specific clinical manifestations and has a high rate of preoperative misdiagnosis [2]. However, I found that the clinical manifestations of this group of patients with thyroid lymphoma still have some common points: (1) thyroid nodules that enlarge rapidly within a short period of time, and the clinical course of this group of patients is relatively short: the shortest is only 1 week, and the longest is only 6 months. The average age was 59 years. Therefore, patients with goiter with the above-mentioned manifestations should be clinically alerted to the possibility of thyroid lymphoma. The diagnosis of thyroid lymphoma is mainly based on pathology. Fine needle aspiration (FNA) has been reported in the literature for the diagnosis of thyroid lymphoma [3], but in our group of two patients who underwent preoperative fine needle aspiration, pathological findings revealed a small number of lymphocytes in one case and a small amount of lymphoid tissue and a little necrotic tissue in one case, both of which failed to confirm the diagnosis. In addition, even intraoperative freezing examination has a high false-negative rate. In this group, all cases were examined by intraoperative freezing examination, and only 3 cases were diagnosed as lymphoma, less than 50%; 1 case was suspected of lymphoma, 1 case of thyroid cancer, and 2 cases of chronic lymphocytic thyroiditis, of which 1 case was diagnosed as lymphoma only after 2 surgical operations to remove the thyroid gland. Therefore, I believe that the diagnosis of thyroid lymphoma by FNA is very difficult, especially for small cell lymphoma with low malignancy. Because the morphology of tumor cells is very similar to normal small lymphocytes, and the diagnosis of lymphoma depends not only on the morphological changes of tumor cells, but also on the structural changes of the tissue to make the diagnosis. It is also difficult to differentiate low grade malignant lymphoma of the thyroid from undifferentiated thyroid cancer and lymphocytic thyroiditis in conventional light microscopic diagnosis, and immunohistochemical examination is required to clarify the diagnosis [4].