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Urbón-sánchez P, Mendoza-Moreno F, Sánchez De Toca-Gómez S, Mañes-Jiménez F, Jiménez-Martín R, Bru-Aparicio M, Laguna-Hernández P, Allaoua-Moussaoui Y, Soto-Schutte S, Quiroga-Valcárcel A, Díez-Alonso M, Lasa Unzúe I, Gutiérrez-Calvo A. Thyroid abscess, an uncommon diagnosis: A case report and mini‑review of the literature. MEDICINE INTERNATIONAL 2024; 4:29. [PMID: 38660126 PMCID: PMC11040282 DOI: 10.3892/mi.2024.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/23/2024] [Indexed: 04/26/2024]
Abstract
Thyroid abscess is a rare entity, commonly experienced by immunocompromised patients, or those who have anatomical abnormalities or a pre-existing thyroid disease. An early diagnosis continued by treatment with antibiotics and drainage of the abscess is the recommended therapeutic strategy for such cases. The present study describes a clinical case of this rare event, and also provides a brief literature review. The present study describes the case of a 48-year-old healthy male with no medical antecedents, apart from acute prostatitis treated with antibiotics for 6 days prior, who visited the Emergency Department of the authors' hospital with neck pain and progressive swelling of the mass. Diagnostic imaging confirmed the authors' suspicion of an abscess and revealed the lesion displacing the airway to the contralateral side. This restricted the mobility of the neck of the patient. As an emergency measure, the patient was then taken to the operating room for a neck examination. A hemithyroidectomy was finally performed. Following a prolonged hospital duration, he was discharged from the hospital and his recovery was uneventful without any voice alterations, hypocalcemia or recurrence.
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Affiliation(s)
- Patricia Urbón-sánchez
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Fernando Mendoza-Moreno
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | | | - Félix Mañes-Jiménez
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Rubén Jiménez-Martín
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Marta Bru-Aparicio
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Pilar Laguna-Hernández
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Yousef Allaoua-Moussaoui
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Sonia Soto-Schutte
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Ana Quiroga-Valcárcel
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Manuel Díez-Alonso
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Inmaculada Lasa Unzúe
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Alberto Gutiérrez-Calvo
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
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Seyedjavadeyn Z, Miratashi Yazdi SA, Samimiat A, Vahedi M. Thyrotoxicosis as a rare presentation in acute suppurative thyroiditis: a case report. J Med Case Rep 2023; 17:428. [PMID: 37833794 PMCID: PMC10576297 DOI: 10.1186/s13256-023-04119-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/04/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Acute suppurative thyroiditis is a rare and potentially life-threatening disease. A few cases of acute suppurative thyroiditis associated with thyrotoxicosis have been reported in adults. We report a case of acute suppurative thyroiditis that was associated with thyrotoxicosis. CASE PRESENTATION We report the case of a 49-year-old Iranian female presented with a painful neck swelling for a week. Computed tomography showed a well-defined gas-filled collection in the left thyroid lobe with an enhancing margin. The patient underwent two-phase surgery, first left thyroid abscess drainage and then total thyroidectomy. The result of histopathology examination was multinodular goiter with abscess formation without malignancy. CONCLUSION Abscess formation and thyrotoxicosis is a very rare condition that occurs at the same time in acute suppurative thyroiditis. Despite antibiotic therapy being the first line of treatment, surgery is also required when antibiotic therapy fails.
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Affiliation(s)
- Zeynab Seyedjavadeyn
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Samimiat
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Matin Vahedi
- Department of General Thoracic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Lesh R, Hellums R, Pichardo P, Wong J, Pellitteri P, Purdy N, Stavrides K, Haugen TW. Thyroid Abscess: A Case Series and Literature Review. EAR, NOSE & THROAT JOURNAL 2023:1455613221150128. [PMID: 36603543 DOI: 10.1177/01455613221150128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE In this retrospective case series, we chronicle six patients presenting with acute suppurative thyroiditis (AST) with progression to thyroid abscess in a single institution. METHODS Patients ranged in age from 16 to 74 years of age. The most common presenting symptoms were progressive unilateral neck pain, swelling, and odynophagia. Other symptoms included hoarseness and systemic signs of infection. Diagnosis of thyroid abscess was made with a CT scan of the neck, fine needle aspiration, and/or incision and drainage (I&D). RESULTS Management included antibiotic therapy, I&D, and thyroidectomy. All patients were successfully treated except for one who developed mediastinitis and died. CONCLUSION A complete literature review was performed to determine etiologies, common findings, and management of similar cases.
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Affiliation(s)
- Randy Lesh
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Ryan Hellums
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Priscilla Pichardo
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Jeff Wong
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Phillip Pellitteri
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Nicholas Purdy
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Kevin Stavrides
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Thorsen W Haugen
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
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Baba HO, Salih AM, Hammood ZD, Rashid RJ, Abdullah IY, kakamad FH, Abdulla BA. Acute suppurative thyroiditis progressing to a thyroid abscess; a case report with review of literature. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2021.100433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Trummer C, Theiler-Schwetz V, Steinberger E, Reisinger AC, Hassler E, Valentin T, Reinisch S, Pilz S. Acute suppurative thyroiditis due to Streptococcus anginosus leading to sepsis and acute respiratory distress syndrome: a case report. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:846-851. [PMID: 34762790 PMCID: PMC10065398 DOI: 10.20945/2359-3997000000420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Acute suppurative thyroiditis (AST) is a rare but potentially life-threatening thyroid disease with a high mortality if left untreated. Thus, differentiation from other thyroid disorders is highly important in clinical practice. A 22-year-old male patient was admitted to a tertiary care hospital with cervical pain, palpitations, thyrotoxicosis, and an inhomogeneously enlarged right thyroid lobe. In view of the clinical findings, subacute thyroiditis (SAT) was suspected and treatment with glucocorticoids was started. After initial amelioration, the patient developed cervical erythema, fever, and recurrent pain. A CT scan showed extensive phlegmonous inflammation and abscess formation, suggestive of AST. We started immediate empiric antibiotic therapy and performed surgical drainage of the abscess formations. Subsequently, the patient developed hypoxic respiratory failure, leading to ICU admission and intermittent need for non-invasive ventilation. Blood and abscess cultures were positive for Streptococcus anginosus. If left untreated, AST represents a potentially life-threatening disease. Thus, in clinically doubtful cases, liberal further assessment by means of cervical CT scans or fine needle aspiration biopsy are strongly advised.
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Affiliation(s)
- Christian Trummer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria,
| | - Verena Theiler-Schwetz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Eva Steinberger
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander C Reisinger
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Eva Hassler
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sabine Reinisch
- Division of General Otorhinolaryngology, Head and Neck Surgery, Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Falhammar H, Wallin G, Calissendorff J. Acute suppurative thyroiditis with thyroid abscess in adults: clinical presentation, treatment and outcomes. BMC Endocr Disord 2019; 19:130. [PMID: 31791298 PMCID: PMC6889346 DOI: 10.1186/s12902-019-0458-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 11/18/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Abscess in the thyroid gland is a rare but severe infectious disease. The condition can have anatomic or iatrogenic underlying causes. If untreated it could be fatal. Pathogens vary considerably. Treatment is intravenous antibiotics, drainage, and sometimes surgery. METHODS The electronic medical records of all adult patients with acute thyroiditis 2003-2017 treated at the Karolinska University Hospital (catchment area 2 million) in Sweden were systematically reviewed. RESULTS Five patients were found in the catchment area. One patient from another region but known to us was also included. Thus, six patients (aged 28-73 years) were included in the study. Median length of hospital stay was 7.5 days (4-79 days). All were treated with antibiotics (intravenous n = 5, oral n = 1). Total antibiotic treatment duration was 13.5 days (10-41 days). Blood cultures were positive in three (streptococcus pneumonia, streptococci sanguineous, pepto streptococci), deep tissue culture in three (Escherichia coli, Candida, Hemophilic influenza) and no positive culture at all in two. Drainage was used in three patients. All patients recovered without recurrences. Surgery was performed twice in the acute phase in one. There was no recurrence during 7 years (3-12) of follow-up, but one patient died after three years (severe heart failure and pneumonia). CONCLUSION Thyroid abscess in adults is extremely rare nowadays in the developed world. With prompt antibiotic therapy, drainage and in some cases thyroidectomy the prognosis seems favourable.
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Affiliation(s)
- Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Göran Wallin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Deptartment of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jan Calissendorff
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Endocrinology Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.
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Campos R, Pérez B, Armengod L, Múñez E, Ramos A. Absceso tiroideo por Lactococcus lactis en paciente inmunocompetente. ACTA ACUST UNITED AC 2015; 62:204-6. [DOI: 10.1016/j.endonu.2014.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/01/2014] [Accepted: 12/05/2014] [Indexed: 12/17/2022]
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Wu C, Zhang Y, Gong Y, Hou Y, Li S, Zou Y, Ge J. Two cases of bacterial suppurative thyroiditis caused by Streptococcus anginosus. Endocr Pathol 2013; 24:49-53. [PMID: 23435638 DOI: 10.1007/s12022-013-9236-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Acute suppurative thyroiditis (AST) is a rare clinical condition. Streptococcus anginosus has a propensity of producing empyema in the head and neck. Here, we reported two cases of AST caused by S. anginosus. A 44-year-old man presented with anterior neck tender swelling and odynophagia for 12 days. He had thyrotoxicosis. He was initially diagnosed as thyroid cancer due to the misleading computed tomography report. Fine needle aspiration (FNA) yielded pus and neutrophils. S. anginosus was isolated from pus. After aspiration of abscess and treatment with sensitive antibiotics, he recovered uneventfully with 3 weeks treatment. He was euthyroid 3 months later. The other case is a 40-year-old women complained of fever and left neck swelling for 20 days. Magnetic resonance imaging showed left neck inflammatory changes. FNA revealed pus and inflammatory cells infiltration. She had moderately decreased level of thyroid-stimulating hormone (TSH). Blood cultures were positive for S. anginosus. After penicillin treatment, TSH level returned to normal range, and the nodule gradually resolved. She recovered uneventfully after 5 weeks treatment. S. anginosus has a previously unappreciated clinical niche in AST. Once AST is clinically concerned, FNA procedure should be performed as early as possible.
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Affiliation(s)
- Chaoneng Wu
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032, China
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Spitzer M, Alexanian S, Farwell AP. Thyrotoxicosis with post-treatment hypothyroidism in a patient with acute suppurative thyroiditis due to porphyromonas. Thyroid 2012; 22:97-100. [PMID: 22136210 DOI: 10.1089/thy.2011.0159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Acute suppurative thyroiditis (AST) is a rare, life-threatening thyroid infection characterized by a tender neck mass and fever. As these features are shared with self-limited subacute thyroiditis (SAT), it is important to differentiate between the two disorders. PATIENT FINDINGS We report a case of AST in a 21-year-old woman who presented with steadily worsening throat pain for 3 weeks, a tender left neck mass, and thyrotoxicosis. She was initially given prednisone for treatment of presumed SAT but then it acutely worsened. Fine needle aspiration yielded pus on gross examination, and she required intubation and emergent surgical drainage to maintain her airway. Culture of the abscess isolated Streptococcus F and Porphyromonas, a gram-negative intracellular anaerobe not previously reported to cause AST. She improved quickly after surgery, developed transient hypothyroidism that did not require treatment with thyroid hormone, and is currently euthyroid. An abnormal piriform sinus fistula was identified on the left using an esophagram. SUMMARY AST may be difficult to clinically differentiate from SAT. Fine needle aspiration revealing pus, culture yielding bacteria or fungi, abscess on ultrasonography and computed tomography, and left-sided predominance are important in the diagnosis of AST. CONCLUSIONS AST should be considered in any patient with SAT who does not rapidly improve following institution of steroids. Further, the presence of thyrotoxicosis does not eliminate AST as an initial diagnosis.
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Affiliation(s)
- Matthew Spitzer
- Division of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts 01583, USA.
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Masuoka H, Miyauchi A, Tomoda C, Inoue H, Takamura Y, Ito Y, Kobayashi K, Miya A. Imaging studies in sixty patients with acute suppurative thyroiditis. Thyroid 2011; 21:1075-80. [PMID: 21875365 DOI: 10.1089/thy.2010.0366] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pyriform sinus fistulae are the major routes of infection in acute suppurative thyroiditis (AST). There have been only a few reports describing imaging studies in AST. We reviewed our imaging studies in patients with AST to elucidate its features so as to facilitate its diagnosis and treatment. METHODS We reviewed ultrasonography (US) examinations, computed tomography (CT) scans, and barium swallow studies performed on 60 patients with the AST who were seen for medical care between 1998 and 2008 and were retrospectively reviewed. All of these patients had pyriform sinus fistulae. RESULTS In the acute inflammatory stage, US showed a hypoechoic lesion spreading in and around the affected thyroid lobe, destruction of the lobe, and abscess formation in the neck. CT scans demonstrated similar features with clearer anatomical involvement and edema in the ipsilateral hypopharynx. These findings allowed easy diagnosis of AST. However, in the early inflammatory stage US showed an unclear hypoechoic area in the affected lobe and CT scans showed a nonspecific low-density area. These findings often led to erroneous diagnoses of subacute thyroiditis. A careful review of the US studies demonstrated that the following findings are characteristic of acute suppurative thyroidits: a perithyroidal hypoechoic space, effacement of the plane between the thyroid and perithyroid tissues, and the hypoechoic lesions being unifocal. The former two are not seen in subacute thyroiditis, and hypoechoic lesions in subacute thyroiditis are usually multiple and often bilateral. In the late inflammatory stage, US and CT scans often showed atrophy and an unclear hypoechoic or low-density area in and around the affected lobe. To detect pyriform sinus fistulae, barium swallow studies are more sensitive than US or CT scans. CONCLUSION During the acute inflammatory stage of AST, both US and CT scans showed inflammatory processes in and around the affected thyroid lobe, although the CT scans more clearly demonstrate the anatomical locations involved. In the early inflammatory stage, these features may lead to an erroneous diagnosis of subacute thyroiditis. Careful US studies should indicate the correct diagnosis, which can then be proven by a barium swallow study or fine-needle aspiration followed by cytological examination and bacterial culturing.
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