Thyroid Abscess: Challenges in Diagnosis and Management

Niharika Yedla,Claudio Tuda,Daniela Pirela,Alex Manzano,Saberio Lo Presti

doi:10.1177/2324709618778709

Niharika Yedla, Claudio Tuda + Show 3 more

Open Access

https://doi.org/10.1177/2324709618778709

Copy DOI

Abstract

Thyroid abscess is an uncommon infectious pathology. The thyroid is highly resistant to infection due to high iodine content, capsular encasement, and rich vascularity. Acute suppurative thyroiditis represents <1% of thyroid diseases that could potentially become a life-threatening endocrine emergency. A 48-year-old woman with AIDS presented with 3 days of fever, tender neck swelling, and methicillin-resistant Staphylococcus aureus bacteremia. Apart from leukocytosis, initial laboratory values including thyroid function tests were normal. The initial plain computed tomography scan of the neck and ultrasound scan of the neck were inconclusive as well. By day 4, she worsened, and on repeat computed tomography scan of the neck with contrast, multiloculated abscesses in the thyroid and retro pharynx were seen, which needed emergent drainage. Acute suppurative thyroiditis, a rare disease, occurs in patients with either preexisting disorders of the thyroid or in the immunocompromised. The most common pathogen is Staphylococcus aureus. In our case, we highlight the fact that initial imaging may be negative in the early stages of acute suppurative thyroiditis and lead to an erroneous diagnosis of subacute thyroiditis. There are less than 5 cases of methicillin-resistant Staphylococcus aureus suppurative thyroiditis reported.

Highlights

The thyroid gland is essentially protected from being seeded by infections due to its anatomy
The iodine content of the gland prevents infections. Even among those with impaired immune systems, acute suppurative thyroiditis (AST) is a rare disease with incidence being less than 1% of all thyroid diseases.[1]
It is most commonly caused by gram-positive aerobes, Staphylococcus aureus being the most prevalent, but there are reports of gram-negative organisms and fungi.[1]

Summary

Introduction

The thyroid gland is essentially protected from being seeded by infections due to its anatomy. The iodine content of the gland prevents infections Even among those with impaired immune systems, acute suppurative thyroiditis (AST) is a rare disease with incidence being less than 1% of all thyroid diseases.[1] It is most commonly caused by gram-positive aerobes, Staphylococcus aureus being the most prevalent, but there are reports of gram-negative organisms and fungi.[1] Extensive PubMed search brought to light less than 5 reported cases of methicillin-resistant Staphylococcus aureus (MRSA) thyroid abscesses.[2,3,4,5] AST is a life-threatening endocrine emergency. By day 4 of hospitalization, the patient had worsening neck pain and stridor She was taken for a stat contrast CT-neck, which revealed multiple abscesses in the thyroid as well as in the retropharyngeal space (Figures 1 and 2).

Conclusion

Findings

Discussion