Acute Suppurative Thyroiditis After Fine-Needle Aspiration Causing Thyrotoxicosis

Abstract

A case of thyrotoxicosis caused by acute suppurative thyroiditis after repeated fine-needle aspiration (FNA) is described. A 39-year-old woman with atopic dermatitis showed rapid enlargement of a left thyroid cyst after a third FNA. She had a high fever, painful swelling of the left thyroid, and elevated thyroid hormone levels. Ultrasonography revealed abscess formation in the left thyroid cyst. The cytologic examination of an FNA specimen showed abundant neutrophils, and culture of the aspirate yielded Staphylococcus aureus. Because antibiotic treatment for 1 month failed to improve the inflammatory findings, the patient subsequently underwent left thyroid lobectomy, which resulted in the normalization of thyroid function and the resolution of inflammation. Thyroid infection had possibly been induced by needle-track seeding, because atopic skin favors colonization by S. aureus because of local immunologic deficiency. FNA is a useful and safe technique for aspirating fluid from thyroid cysts, but special care is required in patients with atopic dermatatis to avoid bacterial infection.

Acute Suppurative Thyroiditis Accompanied by Thyrotoxicosis after Fine-Needle Aspiration: Treatment with Catheter Drainage

“…A few cases thyrotoxicosis developing with AST have been reported to date [3,4,11,12]. Moreover, to our knowledge, acute suppurative thyroiditis associated with thyrotoxicosis after FNA was reported only one case [4]. In this reported case of Nishihara E et al, antibiotic treatment for approximately one month did not improved to the inflammatory findings and left thyroid lobectomy performed.…”

“…Local hematoma and pain are the most common complications of FNA [8]. AST can also develop (though rarely) after thyroid fine needle biopsy performed for diagnostic purposes [1,4,9,10]. Here, we report a case of thyrotoxicosis developing with AST after FNA .…”

“…The infection agent leading to AST generally reaches the thyroid gland through hematogenous or lymphatic spread from respiratory tract infection in adults and may be sinus fistula-mediated in children [3]. Underlying diseases including diabetes mellitus, tuberculosis, and human immunodeficiency virus infection, appear to increase the risk for developing of thyroid abscess [4]. The suppurative process generally develops in the presence of underlying thyroid pathology [5].…”

“…Thyroid hormones may slightly rise in association with destruction of follicular cells, but thyrotoxicosis is rarely seen [4,5]. A few cases thyrotoxicosis developing with AST have been reported to date [3,4,11,12].…”

“…Thyroid hormones may slightly rise in association with destruction of follicular cells, but thyrotoxicosis is rarely seen [4,5]. A few cases thyrotoxicosis developing with AST have been reported to date [3,4,11,12]. Moreover, to our knowledge, acute suppurative thyroiditis associated with thyrotoxicosis after FNA was reported only one case [4].…”