Authors: V Sicilia S Mezitis
Publish Date: 2014/04/09
Volume: 29, Issue: 11, Pages: 997-1000
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 preexisting altered thyroid gland is often the postulated pathogenetic mechanism and it is exceedingly rare in the United States We report the case of an 81yrold 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 intrathyroid 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 broadspectrum antibiotics and/or surgical drainage to avoid serious consequences including severe thyrotoxicosis
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