7435 Thyroid Abscess Post-FNA in an Immunocompetent Host

Abstract

Abstract Disclosure: B. Gautam: None. M.S. Hossain: None. S. Hossain: None. S.C. Kumar: None. H. liao: None. B. Tiwari: None. D.S. Rosenthal: None. Background: Thyroid Fine Needle Aspiration (FNA) is a common diagnostic procedure for thyroid nodules. Most common post FNA complications are minor pain, bruises and small hematomas. Despite being generally safe, FNA can occasionally lead to rare complications, such as thyroid abscess, especially in immunocompromised individuals. This case highlights the development of a thyroid abscess post-FNA in a 42-year-old immunocompetent female. Case Report: A 42-year-old female presented to ED with painful right sided neck lump. She had undergone FNA of right sided thyroid cyst, 10 days ago without any immediate complications as confirmed on post procedural ultrasonogram. She started having right sided neck pain after FNA which progressively got worse overtime associated with fever, chills and difficulty swallowing without any dyspnea or dysphonia. She denied symptoms of hyperthyroidism or hypothyroidism. Family history was significant for thyroid cancer in her mother and thyroid nodule in a sister. On exam: Temp. 101 F, HR 105 beats/min, BP 113/69 mm Hg, RR 18 breaths/min. Neck exam revealed soft, warm, tender mass in right neck region which was mobile with swallowing without any skin discoloration or discharge. The physical exam was otherwise unremarkable. Laboratory investigations showed elevated WBC 18000 (4.5-11 k/mm3) with absolute neutrophil count 14.4 (1.8-7 k/mm3), normal CMP. Thyroid hormone levels were normal: TSH 0.32 Uiu/ml, FT4 1.0 ng/dl), as were anti-TG ab, TSI and anti-TPO ab. CT scan of Neck with IV contrast showed a 2.8 x 2.5 x 3.8 cm homogeneous right thyroid mass with mass effect on the trachea. US thyroid showed a 3.7 x 2.9 x 3.3 cm right thyroid hypoechoic lesion with increased internal echogenicity and peripheral hyperemia, consistent with a thyroid abscess. Patient underwent IR guided drainage of 30 cc thick, dark brown fluid and started on broad spectrum IV antibiotics which was then modified based on the bacteriology report showing presence of gram-variable rods, specifically Corynebacterium, with significant clinical improvement. Discussion: The thyroid gland is considered resistant to infections because of its characteristics such as encapsulation, high iodine content and rich blood supply. Nevertheless, rarely, patients may develop post FNA complications including bacterial thyroiditis, thyroid abscess and retropharyngeal cellulitis, presenting with acute life-threatening complaints. This case highlights the importance of monitoring for these rare complications along with early diagnosis and treatment which involves drainage and targeted antibiotic therapy. In the presence of suspicious findings on ultrasonogram and a strong family history of thyroid cancer, we also like to emphasize rare cases where a thyroid abscess could originate from necrotizing cancer cell, the likely etiology of thyroid abscess in our patient. Presentation: 6/3/2024