P0727 / #2063: CLNICAL CASE OF AN AIRWAY COMPROMISE DUE TO ACUTE SUPPURATIVE THYROIDITIS

Abstract

Aims & Objectives: Acute suppurative thyroiditis, which leads to primary thyroid abscess, is an infrequent thyroid disease. The rich blood supply and lymphatic drainage gives the thyroid gland its resistance to infection. High iodine content is also bactericidal. The objective of this study is to describe a case of upper airway obstruction secondary to a vocal fold paralysis due to an acute suppurative thyroiditis. Methods: Observational, descriptive, transversal and retrospective study. We include the description of a clinical case of thyroiditis in the pediatric intensive care unit of a tertiary hospital in Madrid. Results: A 2-year-old girl presented with inspiratory stridor, odynophagia, malaise and anorexia of one week. Past history of fever, vomiting, diarrhea and 2 kg weight loss. She had goiter on physical examination. Leukocytosis, neutrophilia, CRP 646 mg/L and hyperthyroidism (TSH <0.01 mcU/ml, T4 2.83 ng/dl) on blood tests. Acute suppurative thyroiditis was diagnosed on cervical ultrasound and bilateral paralysis of vocal cords on fibroscopy. Due to airway compromise, she required orotracheal intubation. Worsening of goiter lead to the puncture of thyroid. Parvimonas micra and Streptococcus anginosus were isolated. She received treatment with cefotaxime, clindamycin and corticosteroids. MRI showed findings compatible with possible pyriform sinus fistula. She progressively improved, with disappearance of respiratory distress and decrease of goiter. Secondary hypothyroidism, has required treatment with levothyroxine. Conclusions: Thyroid abscess can be associated with local anatomical defects, such as persistence of the fourth branchial arch. Patients may have destruction of the thyroid gland with subsequent hypothyroidism. Monitoring of thyroid function should be implemented.