MRSA Thyroiditis and Thyrotoxicosis

Abstract

Objective: 1) Learn that methicillin-resistant staphylococcus aureus (MRSA) thyroiditis causing thyrotoxicosis is a rare and potentially life-threatening condition. 2) Understand the diagnosis and management of suppurative thyroiditis and related thyrotoxicosis. 3) Understand the rising incidence of both community-acquired and hospital-acquired MRSA infections. Method: We present a patient with MRSA thyroiditis and thyrotoxicosis who was evaluated by the otolaryngology–head and neck surgery service of an academic, tertiary care hospital in 2012. The literature was also reviewed through a directed PubMed search, and a relevant case was identified and discussed. Results: A patient was transferred from an outside hospital in respiratory failure with a recent history of progressive neck pain and dysphagia. Computed tomography of the neck revealed an enlarged and inflamed thyroid gland, which was causing airway compression. Thyrotoxicosis was subsequently identified. MRSA was cultured in samples from an ultrasound guided thyroid biopsy and a surgical debridement. Antibiotics were started, and the thyrotoxicosis was followed clinically. With this management, the thyrotoxicosis resolved, and hypothyroidism immediately ensued. A literature review revealed only one previously reported case of MRSA thyroiditis and thyrotoxicosis, which resolved with medical management. Conclusion: MRSA thyroiditis with associated thyrotoxicosis represents a rare complication of a bacterium that is becoming more common in community and hospital settings. To our knowledge, this is the second reported case of this particular clinical entity. Prompt identification of a causative organism and thyrotoxicosis can allow for potentially life-saving interventions.