RESUMO
Brucellosis is a zoonotic disease endemic in many developing countries, including Türkiye. Among the species that are pathogenic for humans; Brucella melitensis is isolated from livestock animals like sheep and goats, Brucella abortus from cattle and Brucella suis from pigs. Laboratory diagnosis of infection caused by Brucella species with gram-negative coccobacillus morphology; can be made through characteristic culture features, serological tests and molecular methods. Brucellosis, which has a wide distribution of clinical signs and symptoms; can cause various complications by affecting many organs and systems. Among all complications, the probability of thyroid abscess is less than 1%. In this case report; an example of thyroid abscess, one of the rare complications of brucellosis that is not frequently encountered in the literature, was presented. During the physical examination of a 45-year-old female patient who admitted with the complaint of pain in the neck area, fever, neck swelling, redness and pain that increased with palpation were detected. Leukocytosis, lymphopenia, high sedimentation and CRP, low TSH and high T4 values were detected in laboratory tests and subacute thyroiditis was considered as the preliminary diagnosis. Surgical abscess drainage was planned as the patient's clinical findings progressed during follow-up and spontaneous pus discharged from the midline of the neck. The abscess aspirate sample taken during surgical intervention and the blood culture samples taken before were evaluated microbiologically. Microorganisms that did not grow on EMB agar but grew on 5% sheep blood and chocolate agar at the 72-96th hour of incubation of culture plates; were detected to have gram-negative coccobacillus morphology and positive for catalase, oxidase and urease. Although the Wright test was negative with a titer of 1/20, the Rose Bengal test was positive, Coombs test was positive with a titer of 1/160 and the Brucellacapt test was positive with a titer of >1/5120. Microorganisms growing on culture plates were identified as B.melitensis at the species level with specific antisera. As a result of antibiotic susceptibility tests evaluated according to the European Committee on Antimicrobial Susceptibility Testing version 14.0 (EUCAST v14.0), the isolate was susceptible to rifampicin, doxycycline, gentamicin and trimethoprim-sulfamethoxazole at standart dosing regimen and susceptible to ciprofloxacin and levofloxacin at increased exposure. The patient, who was started on doxycycline and rifampicin combination treatment, was discharged without any complaints. In the diagnosis of infection due to Brucella species, which is one of the pathogens that early diagnosis and initiation of treatment greatly affects the prognosis; in addition to culture, which is the gold standard method, serological tests are also very important. If diagnosis is delayed, complications may develop due to involvement in almost every part of the body, depending on the affected organs and systems. In areas where brucellosis is endemic, patients with symptoms such as neck swelling, shortness of breath and difficulty in swallowing, thyroid tissue involvement due to brucellosis should definitely be considered etiologically.
Assuntos
Abscesso , Brucella melitensis , Brucelose , Brucella melitensis/isolamento & purificação , Brucelose/diagnóstico , Brucelose/microbiologia , Brucelose/tratamento farmacológico , Humanos , Feminino , Abscesso/microbiologia , Abscesso/diagnóstico , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Drenagem , Tireoidite Subaguda/diagnóstico , Tireoidite Subaguda/microbiologia , Tireoidite Subaguda/complicações , Doenças da Glândula Tireoide/microbiologia , Doenças da Glândula Tireoide/diagnósticoRESUMO
Background: The role of severity and duration of inflammatory findings on the development of persistent hypothyroidism and anemia has not been clarified in subacute thyroiditis (SAT). Methods: Demographic data and laboratory parameters of patients with SAT were analyzed retrospectively. Results: Permanent hypothyroidism was observed in 28.1% of patients. Baseline elevated erythrocyte sedimentation rate as defined >74.5 mm/h was found to be associated with permanent hypothyroidism, but the duration of inflammation was not different between the recovered and hypothyroid patients. Baseline hemoglobin values improved without specific therapy in 3.5 months. Conclusion: The initial severity but not the duration of inflammation increases the risk for the development of permanent thyroid dysfunction, and anemia improves with the resolution of inflammation.
[Box: see text].
Assuntos
Hipotireoidismo , Inflamação , Tireoidite Subaguda , Humanos , Tireoidite Subaguda/sangue , Tireoidite Subaguda/diagnóstico , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Estudos Retrospectivos , Inflamação/sangue , Hipotireoidismo/sangue , Sedimentação Sanguínea , Índice de Gravidade de Doença , Anemia/sangue , Idoso , Hemoglobinas/análise , Hemoglobinas/metabolismo , Fatores de TempoRESUMO
Objective: Many cases of subacute thyroiditis (SAT) have been described related to SARS-CoV-2 infection, but no prospective data about follow-up are known. This prospective, longitudinal, 3-year, multicentre study aims to explore the clinical peculiarities and outcome of SAT in relation to SARS-CoV-2 infection, ascertained with antibody dosage. Methods: All patients receiving SAT diagnosis from November 2020 to May 2022 were enrolled. Data on anamnesis, physical examination, blood tests (TSH, freeT4, freeT3, thyroglobulin, anti-thyroid antibodies, C-reactive protein, erythrocyte sedimentation rate, complete blood count), and thyroid ultrasound were collected. At baseline, the presence of IgG against the SARS-CoV-2 spike protein or nucleocapsid was investigated. Patients were evaluated after 1, 3, 6, and 12 months. Results: Sixty-six subjects were enrolled. At baseline, 54 presented with pain, 36 (67%) for at least 15 days. Serum SARS-CoV-2 IgG measurements documented that 7 out of 52 subjects (13.5%) had infection before SAT diagnosis (COVID+). No significant differences between the COVID+ and COVID- groups were found at baseline, except for respiratory symptoms and fever, which were more common in COVID+ (P = 0.039 and P = 0.021, respectively). Among the 41 subjects who completed follow-up, COVID+ and COVID- did not differ for therapeutic approach to SAT or outcome, all having an improvement in neck pain, inflammation parameters, and ultrasound features. Conclusion: This is the first prospective study investigating any difference both at diagnosis and at follow-up between SAT presentation in patients with previous SARS-CoV-2 infection and those without. Our data demonstrate that SARS-CoV-2 does not impact on SAT onset, evolution, and outcome.
Assuntos
COVID-19 , SARS-CoV-2 , Tireoidite Subaguda , Humanos , Tireoidite Subaguda/diagnóstico , Tireoidite Subaguda/sangue , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/imunologia , COVID-19/complicações , Masculino , Feminino , Estudos Prospectivos , Pessoa de Meia-Idade , SARS-CoV-2/imunologia , Adulto , Imunoglobulina G/sangue , Anticorpos Antivirais/sangue , Idoso , Estudos Longitudinais , Glicoproteína da Espícula de Coronavírus/imunologiaRESUMO
La enfermedad por coronavirus SARS-CoV-2 que surgió en el año 2019 (COVID-19), ha obligado al rápido desarrollo de vacunas para prevenir su propagación e intentar controlar la pandemia. Dentro de las vacunas desarrolladas, las primeras en ser aprobadas con una tecnología nueva en el campo de la vacunación, fueron las vacunas basadas en ARNm (ácido ribonucleico mensajero), que lograron tasas de efectividad cercanas al 95 % para la prevención de la enfermedad COVID-19 grave. Los eventos adversos comunes son reacciones locales leves, pero ha habido varios informes de pacientes que desarrollaron tiroiditis subaguda y disfunción tiroidea después de recibir la vacuna contra SARS-CoV-2. Este artículo presenta dos casos de tiroiditis subaguda poco después de recibir la vacuna contra COVID-19
The SARS-CoV-2 coronavirus disease which emerged in 2019 (COVID-19), has forced the rapid development of vaccines to prevent the spread of infection and attempt to control the pandemic. Among the vaccines developed, one of the first to be approved with a new technology in the field of vaccination, was the mRNA (messenger ribonucleic acid) vaccine, with rates of effectiveness close to 95% for the prevention of severe COVID-19 disease. Common adverse events are mild local reactions, but there have been some reports of patients developing sub-acute thyroiditis and thyroid dysfunction after receiving the SARS-CoV-2 vaccine. This article presents two case reports of subacute thyroiditis shortly after receiving the COVID-19 vaccine
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Tireoidite Subaguda/induzido quimicamente , Tireotoxicose/induzido quimicamente , Vacina BNT162/efeitos adversos , ChAdOx1 nCoV-19/efeitos adversos , Tireoidite Subaguda/diagnóstico , Tireoidite Subaguda/tratamento farmacológico , Tireotoxicose/diagnóstico , Tireotoxicose/tratamento farmacológico , Anti-Inflamatórios não Esteroides/uso terapêutico , Bócio/induzido quimicamenteRESUMO
Presentamos un caso de tiroiditis subaguda en un hombre de 51 años que comienza con sintomatología inespecífica de febrícula e intensa astenia de días de evolución. De profesión veterinario, la primera sospecha es de picadura de garrapata, y se solicita en primera instancia una analítica completa con serología y una radiografía de tórax. A los 4 días ya disponemos del resultado de las pruebas solicitadas, y llaman nuestra atención unos valores de reactantes de fase aguda elevados, así como una hormona estimulante de la tiroides (TSH) suprimida con valor de T4 libre de 2,56 ng/dl. En ese mismo momento, ante la sospecha de un cuadro de tiroiditis subaguda, realizamos una ecografía tiroidea y obtenemos imágenes compatibles con nuestra sospecha. Comenzamos tratamiento con antinflamatorios no esteroideos, continuando con corticoides y controles ecográficos periódicos en nuestra consulta, hasta resolución del cuadro clínico. La tiroiditis de De Quervain es una patología que, dada la clínica inespecífica con la que puede presentarse y su resolución espontánea, es posible que pase desapercibida en nuestras consultas de Atención Primaria.(AU)
We report a case of subacute thyroiditis in a 51-year-old man who began to present non-specific symptoms of low grade fever and intense asthenia of a few days clinical course. A vet by profession, the initial suspicion was tick bite. Full analysis with serology and chest x-ray was initially requested. After four days we received the results of the tests requested. Some high acute phase reactant values and a depressed TSH with a free T4 value of 2.56 ng/dl were notable. At this same time, given the suspicion of symptoms of subacute thyroiditis, we performed thyroid ultrasound and obtained images compatible with our suspicions. We commenced treatment with NSAIDs and continued corticosteroids and periodic ultrasound controls in our consultation, until the clinical picture resolved. De Quervain thyroiditis is a pathology which - given the non-specific clinical symptoms it can begin with and their spontaneous resolution - may go unnoticed in our primary care consultations.(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Tireoidite Subaguda/diagnóstico , Cervicalgia , Hipertireoidismo , Atenção Primária à Saúde , Pacientes Internados , Exame Físico , Avaliação de SintomasRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto , Clínicos Gerais/organização & administração , Tireoidite Subaguda/terapia , Tireoidite Subaguda/diagnósticoRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Tuberculose Laríngea/diagnóstico , Tuberculose Laríngea/tratamento farmacológico , Pescoço/patologia , Abscesso , Tireoidite Subaguda/diagnóstico , Tireoidite Subaguda/tratamento farmacológico , Tuberculose Pulmonar/diagnóstico , Diagnóstico Diferencial , Neoplasias Laríngeas/diagnósticoRESUMO
El término tiroiditis comprende un grupo de enfermedades de la glándula tiroides caracterizado por la presencia de inflamación, abarcando entidades autoinmunes y no-autoinmunes. Pueden manifestarse como enfermedades agudas con dolor tiroideo severo (tiroiditis subaguda y tiroiditis infecciosas), y condiciones en las cuales la inflamación no es clínicamente evidente, cursando sin dolor y presentando disfunción tiroidea y/o bocio (tiroiditis inducida por fármacos y tiroiditis de Riedel). El objetivo de esta revisión es aportar un enfoque actualizado sobre las tiroiditis no-autoinmunes cubriendo sus aspectos clínicos, diagnósticos y terapéuticos.
The term thyroiditis comprises a group of thyroid diseases characterized by the presence of inflammation, including autoimmune and non-autoimmune entities. It may manifest as an acute illness with severe thyroid pain (subacute thyroiditis and infectious thyroiditis), and conditions in which the inflammation is not clinically evident evolving without pain and presenting primarily thyroid dysfunction and/or goiter (drug-induced thyroiditis and Riedel thyroiditis). The aim of this review is to provide an updated approach on non-autoimmune thyroiditis and its clinical, diagnostic and therapeutic aspects.
Assuntos
Humanos , Tireoidite/diagnóstico , Tireoidite/etiologia , Tireoidite/terapia , Tireoidite Subaguda/diagnóstico , Tireoidite Supurativa/diagnóstico , Tireoidite Supurativa/etiologia , Tireoidite Supurativa/terapia , Anti-Inflamatórios não Esteroides/uso terapêutico , Doença Crônica , Interferon-alfa/efeitos adversos , Compostos de Lítio/efeitos adversos , Diagnóstico Diferencial , Glucocorticoides/uso terapêutico , Bócio/complicações , Amiodarona/efeitos adversosRESUMO
La tiroiditis de De Quervain, también nombrada como tiroiditis subaguda o tiroiditis de células gigantes, frecuentemente es precedida por un cuadro infeccioso del tracto respiratorio superior. Su diagnóstico es eminentemente clínico; pero el uso de la citología por aspiración con aguja fina de tiroides, confirma o niega el planteamiento clínico según las características citológicas. Fue empleada esta técnica en 6 pacientes con clínica y ultrasonido diferentes y por la necesidad de realizar un correcto diagnóstico diferencial con otras formas de hipertiroidismo con peor pronóstico evolutivo. La citología por aspiración con aguja fina mostró en estos casos ser un arma eficaz para ello, por lo que se decidió realizar esta presentación.
De Quervain's thyroiditis, also called sub-acute thyroiditis or thyroiditis of giant cells, is frequently preceded by an infectious picture of the high respiratory tract. Its diagnosis is eminently clinical; but the usage of the cytology by aspiration of the thyroid with thin needle, confirm or denied the clinical conclusions according to the cytological characteristics. This technique was used in six patients with different clinical and ultrasound results, because of the necessity of arriving to a correct differential diagnosis with other forms of hyperthyroidism with worse evolvable diagnosis. The cytology by aspiration with thin needle in these cases showed to be an efficacious weapon for that, so we decided to prepare this presentation.
Assuntos
Humanos , Masculino , Adulto , Feminino , Idoso , Tireoidite Subaguda/diagnóstico , Tireoidite Subaguda , Relatos de Casos , Técnicas Citológicas/métodosRESUMO
La tiroiditis subaguda, descrita por primera vez por De Quervain en 1904, es la causa principal de dolor tiroideo. Las etiologías más probables son una infección viral o un proceso inflamatorio postinfeccioso. La clínica típica incluye dolor cervical anterior, bocio difuso y alteración de la función tiroidea que sigue un curso predecible en la mayoría de los casos. Presentamos el caso de una paciente de 63 años con una tiroiditis subaguda de inicio focal, con un nódulo tiroideo doloroso a la palpación y manifestaciones sistémicas concomitantes (AU)
Subacute thyroiditis, first described by De Quervain in 1904, is the main cause of thyroid pain. The most likely cause is viral infection or a postviral inflammatoryprocess. Typical clinical manifestations include neck pain, diffuse goiter and thyroid dysfunction with a predictable course in most patients. We present a 63-year-old woman with focal subacute thyroiditis that presented as a painful thyroid nodule with associated systemic symptoms (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Tireoidite Subaguda/diagnóstico , Tireoidite Subaguda/tratamento farmacológico , Aspirina/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêuticoRESUMO
La hipertensión arterial puede asociarse a hiperpotasemia en el contexto de un síndrome hereditario. Describimos el caso de una paciente con estas características diagnosticada de síndrome de Gordon y discutimos la fisiopatología y el tratamiento de esta rara enfermedad
Arterial hypertension may be associated to hyperpotassemia in the context of an hereditary syndrome. We describe the case of a patient with these characteristics diagnosed of Gordon's syndrome and we discuss the pathophysiology and treatment of this rare disease
Assuntos
Feminino , Adulto , Humanos , Hiperpotassemia/complicações , Hipertensão/complicações , Tireoidite Subaguda/diagnóstico , Hipoaldosteronismo/diagnósticoRESUMO
Se informan 9 casos de tiroiditis linfocitica subaguda no dolorosa, cuyas edades oscilaron entre 14 y 42 anos con un promedio de 32.5. Todos tuvieron bocio moderado y disfuncion tiroidea discreta, diagnosticada por vclinica y laboratorio, desaparicion aguda, que remitio espontaneamente en el curso de la evolucion. Cinco presentaron hipertiroidismo con duracion entre 6 a 12 meses con un promedio de 10.2 meses y las otras cuatro, hipotiroidismo con duracion entre 6 y 12 meses, promedio de 10.2. Como caracteristicas de la entidad todas las pacientes presentaron una captacion tiroidea de I 131 ausente, sin causa conocida, en presencia de hiper o hipotiroidismo. En 6 de las 9 pacientes se practico biopsia tiroidea por aspiracion; en 4 la histologia fue sugestiva de tiroiditis de Hashimoto lo que confirmaba aun mas el diagnostico de tiroiditis linfocitica subaguda no dolorosa. Es dificil, si no imposible realizar el diagnostico diferencial entre estas 2 tiroiditis con biopsia por aspiracion (2,5);ambas pueden presentar infiltracion linfocitica, celulas de Hurthle, centros germinativos de linfociticos y cierto grado de fibrosis, siendo estos hallazgos mas intensos en la tiroiditis de Hashimoto en las biopsias tiroideas de nuestros casos 3,4,8,9, en presencia de captacion tiroidea de I 131 ausente, confirma el diagnostico de tiroiditis linfocitica subaguda no dolorosa. Creemos que es la primera vez en la literatura colombiana que se informan casos de esta entidad.
Assuntos
Adolescente , Adulto , Humanos , Feminino , Tireoidite Subaguda/sangue , Tireoidite Subaguda/diagnóstico , Tireoidite Subaguda/epidemiologia , ColômbiaRESUMO
Presentamos el caso clínico de una paciente de 49 años de edad que ingresó en el hospital con el diagnóstico de SFP de 1 mes de evolución, leucocitosis y aumento de la velocidad de sedimentación globular. Varios días después desarrolla molestias en región anterior del cuello y signos de hipertiroidismo. Tras los resultados de las pruebas complementarias (bioquímicos, hormonales, gammagrafía tiroidea y punción aspiración con aguja fina -PAAF- de tiroides) fue diagnosticada de Tiroiditis subaguda con hipertiroidismo. Nosotros pensamos que el agente etiológico fue el virus de Epstein-Barr ya que los anticuerpos heterófilos y específicos fueron positivos. La paciente fue tratada con paracetamol a la dosis de 1.500 mg/día con recuperación completa sin recidiva posterior tras 1 año de seguimiento (AU)
Assuntos
Pessoa de Meia-Idade , Humanos , Biópsia por Agulha , Doença Crônica , Diagnóstico Diferencial , Febre/diagnóstico , Herpesvirus Humano 4 , Síndrome , Glândula Tireoide/patologia , Glândula Tireoide , Glândula Tireoide , Tireoidite Subaguda , Anticorpos Antivirais/sangue , Herpesvirus Humano 4/imunologia , Tireoidite Subaguda/diagnósticoRESUMO
Se analizan las características de 29 casos de tiroiditis subaguda atendidos en el consultorio externo de endocrinología del hospital regional de talca, con incidencia aproximada de un caso cada 2 meses y franco predominio en sexo femenino (90 por ciento). El diagnóstico se basa en la detección de bocio sensible, frecuentemente asociado a fiebre, cefalea y palpitaciones, generalmente con VHS sobre 40 mm/h, T4 elevado y con menor frecuencia T3 y siempre con captación de Iodo muy baja. En el 50 por ciento de los casos resultó efectivo el tratamiento con antiinflamatorios no esteroidales, los restantes requirieron de prednisona, que en los casos más severos debiera ser la primera elección, asociado a betabloqueadores cuando es enecesario. Se insiste en que no debe usarse propiltiouracilo ni Iodo 131. El pronóstico es excelente, con 100 por ciento de mejoría en plazo promedio de 2 semanas
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Tireoidite Subaguda/diagnóstico , Tireoidite Subaguda/tratamento farmacológico , Sintomatologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Febre , Diagnóstico Clínico , Glândula Tireoide/fisiopatologia , PrognósticoRESUMO
La tiroiditis subaguda granulomatosa es una enfermedad viral caracterizada clínicamente por la tríada de: dolor y aumento de volumen de la tiroides en un paciente con síntomas de infección respiratoria viral previa, aumento de la VHS mayor de 40 mm/h, y captación de yodo radioactivo a las 24 h (RAIU) menor de 10 por ciento. Sin embargo, en algunos pacientes el dolor reflejo puede ser mayor que el dolor cervical agudo anterior. A este respecto el autor presenta los casos clínicos de 5 pacientes cuyos primeros síntomas fueron, dolor faríngeo, odinofagia alta, y otalgia refleja, y que llevaron a éstos a consultar al otorrinolaringólogo. Confirmado el diagnóstico recibieron tratamiento corticoesteroidal con remisión rápida y total de la inflamación
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Tireoidite Subaguda/diagnóstico , Tireoidite Subaguda/tratamento farmacológico , Prednisona/uso terapêutico , Diagnóstico Diferencial , Dor de Orelha/etiologia , Sinais e SintomasRESUMO
Paciente femenino que se presenta con síntomas de tirotoxicosis, asociada con niveles sanguíneos elevados de hormonas tiroideas y marcada depresión de la capacitación tiroidea de I 131, así como datos sugestivos de infección por salmonella. La tirotoxicosis ficticia se excluyó de la historia. Los niveles elevados de hormonas tiroideas disminuyeron espontáneamente a límites normales en el curso de varias semanas. El diagnóstico correcto se sospechó sólo después del hallazgo de que la captación tiroidea de I 131 era cercana a cero