Epidermoid cyst abscess of the neck masquerading as a thyroid abscess

SUMMARY

In this case report, we describe a 37-year-old male who presented with fever and tender neck mass. Neck ultrasonography revealed a mixed echogenic multiloculated solid-cystic lesion containing turbid fluid and occupying the right thyroid region. Thyroid function tests showed subclinical hyperthyroidism. The patient was initially diagnosed with thyroid abscess and he was subsequently treated with percutaneous aspiration and i.v. antibiotics; however, his clinical symptoms did not improve. Surgical treatment was then performed and a pathological examination revealed a ruptured epidermoid cyst with abscess formation. No thyroid tissue was identified in the specimen. The patient was discharged uneventfully. However, at the 3-month and 1-year follow-ups, the patient was discovered to have developed subclinical hypothyroidism. Neck ultrasonography revealed a normal thyroid gland. This report demonstrates a rare case of epidermoid cyst abscess in the cervical region, of which initial imaging and abnormal thyroid function tests led to the erroneous diagnosis of thyroid abscess.

LEARNING POINTS

Epidermoid cyst abscess at the cervical region can mimic thyroid abscess. Neck ultrasonography cannot distinguish thyroid abscess from epidermoid cyst abscess. Thyroid function may be altered due to the adjacent soft tissue inflammation.

Urinary total T3 levels as a method to monitor metabolic changes in relation to variation in caloric intake in captive bonobos (Pan paniscus)

Monitoring metabolic activity in wild living animals has become of particular interest in the field of ecological research. Methods for the repeated non-invasive sampling of individuals are needed. Thyroid hormones (TH) are involved in the regulation of metabolic activity, and their measurement can be used as a proxy to monitor metabolic changes. During periods of low energy intake, serum TH levels are reduced, leading to a decrease in metabolic activity. Using urine samples collected during a food restriction experiment in captive bonobos we validated a total triiodthyronin (TT3) enzyme immunoassay (EIA) for the monitoring of metabolic changes. We found that the majority of immune reactivity of the assay in the urine samples could be explained through immunoreactivity to T3. Furthermore, urinary T3 was stable through repeated freeze-thaw cycles but prolonged exposure to room temperature lead to degradation. Most importantly, we found that for all animals urinary total T3 levels were higher when more digestible energy was consumed. We concluded that urinary total T3 measurements are a suitable method for monitoring metabolic changes in bonobos and potentially in a wide range of animal species.

Thyroid function and mental disorders: an insight into the complex interaction

OBJECTIVE

To assess the serum levels of Thyroxine (T4), Triiodothyronine (T3) and the thyroid stimulating hormone (TSH) in patients with depression.

METHODS

Sixty clinically diagnosed and drug naive depressed patients and an equal number of healthy, age and sex matched control subjects were included in this study. The Ham-D scale was used to classify the degree of depression into the mild, moderate and the severe grades. The biochemical parameters (T3, T4 and TSH) were estimated by using commercially available kits. The data were analyzed by using the SPSS-10 software, one way ANOVA and the χ2 test.

RESULT

The female depressive (n = 48) cases outnumbered the male depressive cases. The distributions of the patients in the mild, moderate and the severe categories were similar. A significant decline in the T3 level and an elevation in the T4 level were found in the depressive cases as compared to those in the healthy controls. ANOVA with multiple comparisons testing among the patient group showed no significant difference in the TSH level when the depressive cases with various degrees of depression were compared. A total of twelve depressive patients were found to have thyroid abnormalities.

CONCLUSION

This study therefore observed the presence of thyroid dysfunction among the depressive cases, which is most often characterized as the "Lower Thyroid Syndrome". Thus, the inclusion of the thyroid screening test among the depressive patients may be helpful in the proper management of the cases.