Black thyroid: clinical manifestations, ultrastructural findings, and possible mechanisms.

Ultrastructural examination of three black thyroid glands showed lysosomal accumulations of lipofuscin-like pigment and granular electron-dense material in association with 1) a minocycline-associated black thyroid with normal thyroid function; 2) a minocycline-associated black thyroid with a significant inflammatory component, fibrosis, and primary hypothyroidism; and 3) a black thyroid gland with no exposure to minocycline. The deposition of the pigments in the three cases resulted in macroscopically recognizable black thyroid glands. It is speculated that an imbalance in lysosomal function accounts for this abnormality. The glandular hypofunction documented in case 2 is unique and confirms the need to monitor function carefully in patients who are receiving minocycline. In one case electrondense deposits were identified in the thyroid gland interstitium.