A Case of Acute Suppurative Thyroiditis with Thyrotoxicosis in an Elderly Patient

Abstract

Acute suppurative thyroiditis (AST) is a rare condition, as the thyroid gland is relatively resistant to infection. Thyroid function tests are usually normal in AST. A few cases of AST associated with thyrotoxicosis have been reported in adults. We report a case of AST that was associated with thyrotoxicosis in a 70-year-old woman. We diagnosed AST with thyroid ultrasonography and fine needle aspiration of pus. The patient improved after surgical intervention and had no anatomical abnormality. Fine needle aspiration is the best method for the difficult task of differentiating malignancy and subacute thyroiditis from AST with thyrotoxicosis. Earlier diagnosis and proper treatment for AST might improve the outcome.

Acute Suppurative Thyroiditis Secondary to Tuberculosis with Superimposed Bacterial Infection: A Case Report

“…10 The most discriminating method for differentiating is FNA of the thyroid to detect pus and in the case of subacute thyroiditis, it is possible to observe multinucleated giant cell, granulomatous inflammation, and mononuclear cell infiltration. 1,9 In our case, the diagnoses was clear as ultrasound demonstrated classical finding of hypoechoic collection, FNA aspirated frank pus enabling prompt treatment with empirical antibiotics.…”

“…Distinguishing AST from subacute thyroiditis is crucial as both may present similarly with preceding history of pharyngitis, fever, and painful thyroid swelling. 9 Both these entities are managed differently with an emphasis on early treatment for AST. Typically, ultrasound examination in the acute phase of AST shows a hypoechoic lesion spreading in or around the affected thyroid lobe.…”

“…Laboratory investigations showed leucocytosis TWBC 17.6 x 10 9 /L with neutrophil predominance and elevated inflammatory markers ESR 98 mm/hour, CRP 105.8 mg/L (<5.0). Negative HIV screening and fasting glucose of 5.1 mmol/L ruled out immunocompromised state.…”

Subakute Thyreoiditis und akute suppurative Thyreoiditis

“…Die AST stellt eine seltene, jedoch möglicherweise lebensbedrohliche Erkrankung der Schilddrüse dar [2], deren Inzidenz in der Literatur mit 0,1-0,7 % aller Schilddrüsenerkrankungen angegeben wird [32]. Dies wird unter anderem dadurch erklärt, dass die Schilddrüse ein abgekapseltes Organ mit ausreichender Versorgung durch Blut-und Lymphgefäße darstellt, das außerdem durch die hohe intrathyreoidale Jodkonzentration gegenüber Infekten relativ unanfällig ist [33]. Den pathogenetischen Hintergrund der AST stellt eine bakterielle Infektion der Schilddrüse mit einem breiten möglichen Keimspektrum dar, wobei der Großteil der Fälle durch grampositive oder gramnegative Aerobier ausgelöst wird [2].…”

Brief Review of Articles in 'Endocrinology and Metabolism' in 2013

“…They found TAMs in primary PTC tumors with lymph node metastasis, and higher TAM densities were related to larger tumors, suggesting a tumorigenic role of TAMs in human PTCs [ 6 ]. Interesting case reports about various thyroid diseases were presented in 2013 issues of ' Endocrinology and Metabolism ' [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”