Recommended Citation
Hassan H, Waheeduddin S, MacDonald W. A Rare Case Presentation of a Common Condition: A Large Laryngeal Gouty Tophus. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Introduction/Background:
Laryngeal gout is a rare manifestation of advanced gout involving monosodium urate crystal deposition in laryngeal structures, such as the thyroid cartilage or vocal cords. It can cause hoarseness and dysphagia or present as an asymptomatic anterior neck mass. Patients of Hmong ethnicity have a genetic predisposition to high gout prevalence and earlier disease onset.
Description:
A 29-year-old Hmong male with chronic hyperuricemia presented with a one-year history of progressive anterior neck swelling and diffuse polyarticular tophi. CT imaging revealed a 4.8 x 3.6 x 2.7 cm calcified mass between the hyoid and thyroid cartilage, initially suspected to be ectopic thyroid tissue. Ultrasound showed a structure impenetrable by echoes, suggesting dense crystal deposition. Fine needle aspiration confirmed a gouty tophus via needle-shaped crystals with negative birefringence. The patient was successfully managed with high-dose allopurinol and anti-inflammatory medications.
Discussion:
Laryngeal gouts can mimic thyroid malignancy, making clinical context—such as ethnic predisposition and existing tophi—essential for diagnosis. Ultrasound may aid differentiation by showing acoustic shadowing, which is uncommon in soft-tissue thyroid lesions. While asymptomatic tophi are treated with medical urate-lowering therapy targeting levels < 6mg/dL, surgical intervention is reserved for airway obstruction or other complications. Given the rarity of laryngeal gout, further research is warranted to better define its true incidence, characteristic imaging features across modalities, and optimal diagnostic pathways. Moreover, prospective studies evaluating long-term outcomes of medical versus surgical management could inform evidence-based treatment guidelines and improve patient care.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
A Rare Case Presentation of a Common Condition: A Large Laryngeal Gouty Tophus
Introduction/Background:
Laryngeal gout is a rare manifestation of advanced gout involving monosodium urate crystal deposition in laryngeal structures, such as the thyroid cartilage or vocal cords. It can cause hoarseness and dysphagia or present as an asymptomatic anterior neck mass. Patients of Hmong ethnicity have a genetic predisposition to high gout prevalence and earlier disease onset.
Description:
A 29-year-old Hmong male with chronic hyperuricemia presented with a one-year history of progressive anterior neck swelling and diffuse polyarticular tophi. CT imaging revealed a 4.8 x 3.6 x 2.7 cm calcified mass between the hyoid and thyroid cartilage, initially suspected to be ectopic thyroid tissue. Ultrasound showed a structure impenetrable by echoes, suggesting dense crystal deposition. Fine needle aspiration confirmed a gouty tophus via needle-shaped crystals with negative birefringence. The patient was successfully managed with high-dose allopurinol and anti-inflammatory medications.
Discussion:
Laryngeal gouts can mimic thyroid malignancy, making clinical context—such as ethnic predisposition and existing tophi—essential for diagnosis. Ultrasound may aid differentiation by showing acoustic shadowing, which is uncommon in soft-tissue thyroid lesions. While asymptomatic tophi are treated with medical urate-lowering therapy targeting levels < 6mg/dL, surgical intervention is reserved for airway obstruction or other complications. Given the rarity of laryngeal gout, further research is warranted to better define its true incidence, characteristic imaging features across modalities, and optimal diagnostic pathways. Moreover, prospective studies evaluating long-term outcomes of medical versus surgical management could inform evidence-based treatment guidelines and improve patient care.
Affiliations
Aurora St. Luke's Medical Center