Abstract
Acute suppurative thyroiditis is a very uncommon disorder, most often arising in children with congenital conditions connecting the thyroid directly to the oropharynx, such as a piriform fistula or thyroglossal duct. Accordingly, the most common causative agents are those which can colonize the oral mucosa and spread to the thyroid contiguously, such as Streptococcus species, Staphylococcus species and anerobes. In adults, a hematogenous spread to a pre-existing altered thyroid gland is often the postulated pathogenetic mechanism, and it is exceedingly rare in the United States. We report the case of an 81-yr-old woman with acute suppurative thyroiditis secondary to Escherichia coli (E. coli) infection. The patient presented with fevers, chills, dysuria and recent painful neck swelling. Thyroid ultrasound and neck computed tomography revealed a multinodular goiter and an intra-thyroid abscess. An otolaryngology evaluation and barium swallow failed to show a piriform fistula. Thyroid hormone levels were consistent with hyperthyroidism. Urine cultures were positive for E. coli. The patient subsequently developed a clinical picture consistent with severe thyrotoxicosis, which rapidly resolved after medical treatment, appropriate antibiotics and surgical drainage of the thyroid. Abscess material also grew E. coli. Thus, acute suppurative thyroiditis secondary to sepsis can complicate an otherwise asymptomatic multinodular goiter and should be promptly treated with broad-spectrum antibiotics and/or surgical drainage to avoid serious consequences, including severe thyrotoxicosis.
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References
Brook I. Microbiology and management of acute suppurative thyroiditis in children. Int J Pediatr Otorhinolaryngol 2003, 67: 447.
Berger SA, Zarszein J, Villapena P, Mittman N. Infectious diseases of the thyroid gland. Rev Infect Dis 1983, 5: 108–22.
McHenry CR, Paras F Jr, Liu YC, Rodgers M. Acute suppurative thyroiditis in a primary intrathoracic goiter. Endocr Pract 1997, 3: 14–8.
Andres JC, Nagalla R. Acute bacterial thyroiditis secondary to urosepsis. J Am Board Fam Pract 1995, 8: 128–9.
Barton GM, Shoup WB, Bennett WG, Williams JB, Vesely DL. Combined Escherichia coli and Staphylococcus aureus thyroid abscess in an asymptomatic man. Am J Med Sci 1998, 295: 133–6.
Elias AN, Kyaw T, Winikoff J, Gwinup G. Acute suppurative thyroiditis. J Otolaryngol 1985, 14: 17–9.
Saksouk F, Salti IS. Acute suppurative thyroiditis caused by Escherichia coli. Br Med J 1977, 2: 23–4.
Himsworth RL, Kark AE. Studies on a case of suppurative thyroiditis. Acta Endocrinol (Copenh) 1977, 85: 55–63.
Nmadu PT. Infective thyroiditis in northern Nigeria: a fifteen year study. East Afr Med J 1989, 66: 748–51.
Cavalieri RR. The effects of nonthyroid disease and drugs on thyroid function tests. Med Clin North Am 1991, 75: 28–9.
Fukata S, Miyauchi A, Kuma K, Sugawara M. Acute suppurative thyroiditis caused by an infected piriform sinus fistula with thyrotoxicosis. Thyroid 2002, 12: 175–8.
Yung BC, Loke TK, Fan WC, Chan JC. Acute suppurative thyroiditis due to foreign body-induced retropharyngeal abscess presented as throtoxicosis. Clin Nucl Med 2000, 25: 249–52.
Nieuland Y, Tan KY, Elte JW. Miliary tuberculosis presenting with thyrotoxicosis. Postgrad Med J 1992, 68: 677–9.
Walsh CH, Dunne C. Hyperthyroidism associated with acute suppurative thyroiditis. Ir J Med Sci 1992, 161: 137.
Nicoloff JT. Thyroid storm and myxedema coma. Med Clin North Am 1985, 69: 1005–117.
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Sicilia, V., Mezitis, S. A case of acute suppurative thyroiditis complicated by thyrotoxicosis. J Endocrinol Invest 29, 997–1000 (2006). https://doi.org/10.1007/BF03349213
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DOI: https://doi.org/10.1007/BF03349213