scholarly journals Epidermoid cyst abscess of the neck masquerading as a thyroid abscess

2020 ◽  
Vol 2020 ◽  
Author(s):  
Waralee Chatchomchaun ◽  
Yotsapon Thewjitcharoen ◽  
Karndumri Krittadhee ◽  
Veekij Veerasomboonsin ◽  
Soontaree Nakasatien ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Epidermoid Cyst ◽  
Clinical Symptoms ◽  
Thyroid Tissue ◽  
Cervical Region ◽  
Pathological Examination ◽  
List Type ◽  
Thyroid Function Tests ◽  
Function Tests ◽  
Thyroid Abscess

Summary In this case report, we describe a 37-year-old male who presented with fever and tender neck mass. Neck ultrasonography revealed a mixed echogenic multiloculated solid-cystic lesion containing turbid fluid and occupying the right thyroid region. Thyroid function tests showed subclinical hyperthyroidism. The patient was initially diagnosed with thyroid abscess and he was subsequently treated with percutaneous aspiration and i.v. antibiotics; however, his clinical symptoms did not improve. Surgical treatment was then performed and a pathological examination revealed a ruptured epidermoid cyst with abscess formation. No thyroid tissue was identified in the specimen. The patient was discharged uneventfully. However, at the 3-month and 1-year follow-ups, the patient was discovered to have developed subclinical hypothyroidism. Neck ultrasonography revealed a normal thyroid gland. This report demonstrates a rare case of epidermoid cyst abscess in the cervical region, of which initial imaging and abnormal thyroid function tests led to the erroneous diagnosis of thyroid abscess. Learning points: Epidermoid cyst abscess at the cervical region can mimic thyroid abscess. Neck ultrasonography cannot distinguish thyroid abscess from epidermoid cyst abscess. Thyroid function may be altered due to the adjacent soft tissue inflammation.

scholarly journals Thyroid Abscess Initially Presenting as Destructive Thyroiditis With Subsequent Hypothyroidism

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A961-A961
Author(s):  
Ahl Jeffrey Caseja ◽  
Richard L Wang ◽  
Samer Nakhle
Keyword(s):  
Thyroid Gland ◽  
Thyroid Function ◽  
Fluid Collection ◽  
Neck Mass ◽  
Vascular Supply ◽  
Thyroid Function Tests ◽  
Ct Guided ◽  
Hormone Synthesis ◽  
Function Tests ◽  
Thyroid Abscess

Abstract Introduction: Due to its rich vascular supply and high iodine content infection of the thyroid gland is rare and is uncommonly associated with hyperthyroidism. We report a case of a thyroid abscess presenting with hyperthyroidism with subsequent hypothyroidism in an immunocompetent patient. Clinical Case: A 34-year old female with no past medical history presented with an enlarging neck mass associated with worsening, non-radiating throat pain of three-week duration associated with dysphagia. She reports 15-lb weight loss and palpitations. On presentation vital signs were within normal range. Physical examination revealed a diffusely tender anterior neck mass. Her thyroid function tests revealed TSH 0.01 uIU/mL (0.358-3.74), FT4 2.4 ng/dL (0.76-1.46), TSI <0.10 IU/L (0.00-0.55), TPO 12 IU/mL (0-34). Laboratory workup was also significant for leukocytosis, thrombocytosis, and hyponatremia. Thyroid ultrasound revealed a large, irregularly shaped, multiloculated fluid collection involving both lobes measuring 6.4 x 4.8 x 2.0 cm. She was started on Vancomycin and Ampicillin/Sulbactam, Metoprolol, and Methimazole. Needle aspiration of 30 cc of purulent material was performed with culture showing a heavy growth of streptococcus constellatus sensitive to penicillin. After a 4-day inpatient stay, she was discharged with Amoxicillin/Clauvanate as well as Methimazole 10mg BID. Ten days after being discharged, the patient again presented to the emergency department with complaint that the neck mass had increased in size. CT neck showed a 5.1 x 2.8 x 0.8 cm lobulated fluid collection. CT-guided drainage was performed, cytology and wound culture were found to be unremarkable. Thyroid function tests revealed she was hypothyroid with TSH 31.157 uIU/mL and FT4 of 0.72 ng/dL. Upon discharge, Methimazole was discontinued and she was started on Levothyroxine 75 mcg daily. Due to failure of prior antibiotics, she received a 14-day course of IV Ceftriaxone. Outpatient follow-up eight weeks later showed she was euthyroid on Levothyroxine 75 mcg with ultrasound revealing small thyroid gland with resolution of the abscess. Conclusion: Hyperthyroidism in the setting thyroid abscess is secondary to destructive thyroiditis. As there is no increase in thyroid hormone synthesis, there is no role for treatment with antithyroid medication. Symptomatic control with beta-blocker, surgical drainage, and IV antibiotics are recommended for cases of thyroid abscesses. If infection persists or extensive necrosis develops, thyroidectomy may be indicated. Hypothyroidism can be a consequence of destructive thyroiditis as was seen in this patient.

scholarly journals An autoimmune cause of confusion in a patient with a background of hypothyroidism

2019 ◽  
Vol 2019 ◽  
Author(s):  
Jonathan Brown ◽  
Luqman Sardar
Keyword(s):  
Thyroid Function ◽  
Thyroid Stimulating Hormone ◽  
Healthy Population ◽  
List Type ◽  
Thyroid Function Tests ◽  
Thyroid Antibodies ◽  
Fluid Analysis ◽  
Normal Thyroid Function ◽  
Function Tests ◽  
Antibody Titres

Summary A 68-year-old previously independent woman presented multiple times to hospital over the course of 3 months with a history of intermittent weakness, vacant episodes, word finding difficulty and reduced cognition. She was initially diagnosed with a TIA, and later with a traumatic subarachnoid haemorrhage following a fall; however, despite resolution of the haemorrhage, symptoms were ongoing and continued to worsen. Confusion screen blood tests showed no cause for the ongoing symptoms. More specialised investigations, such as brain imaging, cerebrospinal fluid analysis, electroencephalogram and serology also gave no clear diagnosis. The patient had a background of hypothyroidism, with plasma thyroid function tests throughout showing normal free thyroxine and a mildly raised thyroid-stimulating hormone (TSH). However plasma anti-thyroid peroxidise (TPO) antibody titres were very high. After discussion with specialists, it was felt she may have a rare and poorly understood condition known as Hashimoto’s encephalopathy (HE). After a trial with steroids, her symptoms dramatically improved and she was able to live independently again, something which would have been impossible at presentation. Learning points: In cases of subacute onset confusion where most other diagnoses have already been excluded, testing for anti-thyroid antibodies can identify patients potentially suffering from HE. In these patients, and under the guidance of specialists, a trial of steroids can dramatically improve patient’s symptoms. The majority of patients are euthyroid at the time of presentation, and so normal thyroid function tests should not prevent anti-thyroid antibodies being tested for. Due to high titres of anti-thyroid antibodies being found in a small percentage of the healthy population, HE should be treated as a diagnosis of exclusion, particularly as treatment with steroids may potentially worsen the outcome in other causes of confusion, such as infection.

Hypothyroidism in Down's Syndrome

1988 ◽  
Vol 153 (1) ◽  
pp. 102-104 ◽  
Author(s):  
Chinta Mani
Keyword(s):  
Clinical Features ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Down's Syndrome ◽  
Thyroid Tissue ◽  
Down’S Syndrome ◽  
Thyroid Function Tests ◽  
Function Tests

Fifty-five adult Down's syndrome subjects resident at Northgate Hospital were screened for the presence of thyroid dysfunction. Approximately 50% of the subjects had clinical features suggestive of hypothyroidism, sufficient to require thyroid-function tests. Twenty-two per cent of the total suffered from some degree of hypothyroidism, and 16% had positive antibodies to thyroid tissue.

scholarly journals Investigation prior to thyroglossal duct cyst excision

2012 ◽  
Vol 94 (3) ◽  
pp. 181-184 ◽  
Author(s):  
J Joseph ◽  
K Lim ◽  
J Ramsden
Keyword(s):  
Thyroid Function ◽  
Best Practice ◽  
Thyroid Tissue ◽  
Ectopic Thyroid ◽  
Thyroid Function Tests ◽  
Duct Cyst ◽  
Cyst Excision ◽  
Ectopic Thyroid Tissue ◽  
Function Tests ◽  
Neck Lump

INTRODUCTION Investigation of the anterior midiine neck lump has been debated over the years with little agreement on best practice. Thyrogiossai duct cysts (TDCs) are the most common aetiology. A TDC may contain ectopic thyroid tissue, which may affect the decision to excise. METHODS A computerised survey was sent to a representative sample of UK-based ENT surgeons to determine current practice in investigation of presumed TDCs and the incidence of ectopic thyroid tissue. RESULTS Overall, 95% of those surveyed use ultrasonography, with 32% also arranging thyroid function tests. Fifteen per cent had encountered absent normal thyroid tissue in the presence of a midiine neck swelling. In 64% of cases this represented the only functioning thyroid tissue. Thyroid function tests were normal in all but two cases. CONCLUSIONS The results show a significant change in practice over the last decade. All surgeons would arrange some form of investigation of a presumed TDC, with the vast majority using ultrasonography. Radioisotope scanning should only be used if the ultrasonography or thyroid function tests are abnormal. The incidence of ectopic thyroid tissue in this survey was higher than previously calculated, with a 0.17% prevalence of midiine neck lumps representing the only functioning thyroid tissue.

A METHOD FOR EVALUATING AN EXPERIMENTAL ATHYREOSIS

1972 ◽  
Vol 70 (2) ◽  
pp. 289-294 ◽  
Author(s):  
K. Schimmelpfennig ◽  
A. Kaul ◽  
U. Haberland
Keyword(s):  
Weight Loss ◽  
Thyroid Tissue ◽  
Cervical Region ◽  
List Type ◽  
Experimental Animals

ABSTRACT A micro-131I-test is presented which allows an easy separation of completely surgically thyroidectomised experimental animals from animals with aberrant or residual thyroid tissue. The application of the method is easy and not time-consuming: the total time spent on one animal is approximately 3 min. The method is based on the principle that the 131I storage is measured over the cervical region. The application of this method gives the following advantages: When performing studies with proven athyroid rats it is not necessary subsequently to demonstrate athyreosis (histologically, BMR, or PBI). Time-consuming experiments with animals which are not definitely athyroid can be avoided. The additional fractionated radio-iodine resection after surgical thyroidectomy, used by many authors to destroy residual thyroid tissue, becomes superfluous. Such a procedure takes 4 to 8 weeks. The animals may be used after a 5-day-period. This excludes secondary changes like weight loss and disturbed development which have to be taken into consideration when using a radio-iodine resection.

In a bind: abnormal thyroid function tests

2019 ◽  
Author(s):  
Catriona Hilton ◽  
Farhan Ahmed ◽  
Asif Ali
Keyword(s):  
Thyroid Function ◽  
Thyroid Function Tests ◽  
Function Tests
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