THYROID ABSCESS: A CASE SERIES

Thyroid abscess is a rare surgical pathology, accounting for less than 0.7% of surgical pathologies involving the thyroid 1,2 gland. This is due to its rich blood supply and lymphatic drainage, high concentration oodine that inhibits bacterial growth, protective brous capsule, and fascial planes 2–4 separating it from other neck structures. It may lead to complications like septicaemia, paralysis of the vocal cords, retropharyngeal abscess and suppurative media stinitis and 2 may occasionally lead to osteomyelitis or septic thrombophlebitis. It 5 may also lead to tracheal and oesophageal perforation. The 6 left lobe is commonly affected. If left untreated, thyroid abscess can be life threatening resulting in a mortality of 12% 6 or more

Migratory Foreign Body Presenting with Thyroid Abscess

Introduction The most common complication following accidental ingestion of a foreign body is entrapment in the upper digestive tract. Spontaneous penetration of a foreign body through the upper digestive tract and migration into the soft tissues of the neck is very uncommon. Consequences from such migratory foreign body can be serious and potentially fatal. Case Report Thirty six years old female presented with history of accidental ingestion of an unknown foreign body 3 days back. Clinical examination, plain radiography, hypopharyngoscopy and oesophagoscopy failed to find out the foreign body. Thereafter the patient developed thyroid abscess which was confirmed by computed tomography. Surprisingly we discovered the foreign body during surgical exploration of neck. Conclusion In a case of accidental ingestion of foreign body, even if initial evaluation with endoscopy and plain radiography are negative, the patient should be followed closely until resolution of symptoms. A high index of suspicion of migration of foreign body should be maintained. Retrieval of migratory foreign body needs surgical expertise and experience.

Thyroid Gland Abscess: Uncommon complication

The thyroid gland is naturally resistant to infectious processes, which explains the rarity of thyroid abscess. It represent about 0.1% of the surgical thyroid pathology. We report in this article a case of thyroid gland abscess in a 61 year-old man who was followed for diabetes and hypothyroidism with poor adherence, who consulted in emergency department for acute neck swelling. CT scan showed a fluid collection of the left thyroid lobe. The patient was operated, and histopathological examination concluded of laryngeal carcinoma associated to thyroid papillary carcinoma.

Thyroid Gland Abscess: Uncommon complication

The thyroid gland is naturally resistant to infectious processes, which explains the rarity of thyroid abscess. It represent about 0.1% of the surgical thyroid pathology. We report in this article a case of thyroid gland abscess in a 61 year-old man who was followed for diabetes and hypothyroidism with poor adherence, who consulted in emergency department for acute neck swelling. CT scan showed a fluid collection of the left thyroid lobe. The patient was operated, and histopathological examination concluded of laryngeal carcinoma associated to thyroid papillary carcinoma.

Thyroid Abscess Initially Presenting as Destructive Thyroiditis With Subsequent Hypothyroidism

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.