An Idiopathic Sterile Thyroid Abscess in a Five-Year-Old Child.

We would like to share a case study of a five-year-old child who complained of a painful mass on the front of his neck, with a fever of 98°F. Sometimes thyroid abscesses may be overlooked due to their rarity and are lower down on our list of differential diagnoses. Neck ultrasonography confirmed our findings. A thorough analysis of the literature showed that causal bacteria are required for almost all abscesses. However, in our instance, the aspirated fluid culture revealed no growth, indicating that the abscess was sterile. When patients present with severe neck swelling, this case report emphasizes the significance of considering thyroid abscess as one of the differential diagnoses since early detection is critical to minimize the risk of complications.

Thyroid abscess associated with transient hyperthyroidism in an adolescent girl: a rare case report and review of the literature.

OBJECTIVES: To report an unusual case of thyroid abscess associated with thyroid dysfunction in an adolescent girl who has a normal anatomic structure of the thyroid gland. CASE PRESENTATION: A 15-year-old adolescent girl presented with a history of fever, sore throat, and neck swelling for 10 days duration. Contrast-enhanced computed tomography neck showed findings suggestive of an abscess involving the left lobe of the thyroid gland. She had low TSH and elevated T3 and T4 levels. Here, we report a case of thyroid abscess associated with transient hyperthyroidism in an immunocompetent girl who was successfully managed with parental antibiotics without incision and drainage. CONCLUSIONS: Thyroid abscess can present with hyperthyroidism in children. So it is important to monitor all children who have thyroid abscesses for the development of permanent hypothyroidism later on. It's important to diagnose this condition as soon as possible and begin antibiotic therapy appropriately.

Chronic Suppurative Thyroid Abscess: A Case Report.

Thyroid abscess is a rare occurrence and is characterized by an accumulation of pus within the thyroid gland. It most commonly forms as a sequela of acute suppurative thyroiditis, and it presents as a painful swelling of the anterior neck with fever. Patients may also develop referred ear pain and compressive symptoms such as difficulty breathing and swallowing as the abscess enlarges. On examination, the swelling is often associated with erythema, local rise of temperature, and tenderness. Laboratory investigations may reveal leukocytosis, elevated acute phase reactants, and an abnormal thyroid function test. Despite advancements in diagnostic modalities and treatment approaches, literature on thyroid abscesses remains limited. We present a unique case of a long-standing thyroid abscess resulting from chronic suppuration which did not exhibit any of the mentioned expected findings seen in other cases. This patient was euthyroid, and laboratory investigations showed no significant abnormality. It was successfully treated with total thyroidectomy and appropriate antibiotics.

Giant Thyroid Gland Abscess Causing Upper Airway Obstruction: A Case Report.

Background: Thyroid gland abscess is a rare pathology with life-threatening complications when there is a delay in diagnosis. However, physicians should be aware of and consider this differential in patients with anterior neck swelling having acute onset compressive symptoms to ensure early diagnosis and management. Case Presentation: A 62-year-old female patient presenting with worsening of painful anterior neck swelling with associated fever, shortness of breath, and difficulty swallowing. The patient was found to have a thyroid abscess causing upper airway obstruction, against a background of follicular nodular disease found on clinical examination, cytology and fluid analysis from aspirate, biopsy, ultrasonography, and computed tomography. The patient was managed with endotracheal intubation and was subsequently discharged after recovery with antibiotic therapy, incision and drainage, and thyroid lobectomy. Conclusion: Thyroid abscess is an uncommon, critical clinical condition with high morbidity and mortality. Thyroid gland abscess should be considered while evaluating patients presenting with acute onset anterior neck swelling. Satisfactory clinical outcomes could be achieved with early diagnosis and proper management.

Successful Treatment of a Thyroid Abscess in a Pediatric Patient: A Case Report.

Thyroid abscess, or acute suppurative thyroiditis (AST), is an exceedingly rare condition, particularly in the pediatric population. It often results from congenital anomalies or is secondary to infections. Despite its rarity, prompt diagnosis and management are crucial to prevent serious complications. We report a case of a five-year-old girl with no significant medical history who presented with a two-week history of anterior neck swelling, odynophagia, fever, and leukocytosis. Notably, the patient did not exhibit symptoms of thyroid dysfunction. Initial treatment with antibiotics for a suspected bacterial infection at a private clinic did not lead to improvement. Ultrasound and computed tomography scans revealed a multiloculated abscess within the left thyroid lobe. The patient underwent successful incision and drainage, supported by antibiotic therapy, resulting in a full recovery without complications. Imaging studies played a critical role in diagnosing and guiding the management of this condition. Thyroid abscess, though rare, should be part of the differential diagnosis for pediatric patients presenting with acute neck swelling, fever, and pain. Early diagnosis and appropriate management, typically involving surgical drainage and antibiotics, are essential for a favorable outcome.

Rare Thyroid Diseases Mimicking or Concealing Primitive Thyroid Neoplasms: A Call for a "Check and Double-Check" Clinical Mindset.

Clinical endocrinologists encounter in their practice patients with thyroid diseases on a daily basis. Still, diagnosis of rare structural thyroid disorders can be quite challenging. In some instances, they do not only impersonate but can also conceal, other conditions such as thyroid carcinomas. We describe a series of patients with structural thyroid disorders including 1) anaplastic thyroid carcinoma initially presenting with features of thyroid abscess; 2) unicentric hyaline vascular Castleman's disease of the thyroid embedded in a stroma of papillary thyroid carcinoma; and 3) primary thyroid lymphoma with a rapid and fulminant evolution. The common challenge in the diagnosis of these cases lies in both their low incidence and their complex presentation. We use the presentation of these cases to raise the attention related to their identification. We highlight the need for precision diagnosis to enable a patient-tailored management approach and improve patient outcomes.

Acute Suppurative Thyroiditis in Childhood: An Atypical Presentation.

Neck stiffness is a common clinical sign in children presenting to the emergency department that may indicate a wide variety of diagnoses. Acute suppurative thyroiditis (AST) is an infection of the thyroid gland caused by a bacterium, virus, or, less commonly, fungus. It presents as an acute or subacute development of an anterior cervical mass, with associated inflammatory signs. The pressure upon neck muscles may be reflected as a limitation of cervical mobility. AST is often preceded by an upper respiratory tract infection, and pyriform sinus fistula is the most common predisposing factor. It is particularly uncommon in the pediatric age, with limited cases reported in the literature. Therefore, a heightened suspicion is required for proper diagnosis and timely intervention, due to its high mortality. Prompt treatment with broad-spectrum parenteral antibiotic therapy and drainage is mandatory to prevent the numerous complications associated, namely, mediastinitis and sepsis. We report the case of a two-year-old female child admitted with a two-week history of intermittent high-grade fever and sore throat, followed by prostration and limitation in neck movement on admission. Examination revealed neck stiffness with positive Kernig and Brudzinski signs. The laboratory tests showed elevated inflammatory parameters. Cranial computed tomography (CT) scan and lumbar puncture were normal. On day 2 after admission, an anterior cervical mass with slight signs of fluctuation was detected. Ultrasound was compatible with a hemorrhagic/overinfected thyroid nodule, and the patient was started on broad-spectrum antibiotics. Due to clinical worsening, a cervical CT scan was performed, which documented a thyroid abscess with extension into the retropharyngeal space. She underwent surgical drainage, and Streptococcus anginosus and mixed anaerobes were isolated, sensitive to ongoing antibiotherapy. On multidisciplinary follow-up, an esophageal barium study, laryngoscopy, and cervical magnetic resonance imaging (MRI) were performed, revealing no anatomical defects. AST is a rare disease in children, but potentially fatal, so its early recognition and treatment are essential. We aim to draw attention to this disease and its differential diagnosis to reduce the associated morbimortality.

Thyroid abscess associated with thyrotoxicosis caused by Yersinia enterocolitica subsp. palearctica in a patient with follicular adenoma of the thyroid gland.

BACKGROUND: Yersinia enterocolitica is a gram-negative zoonotic bacterial pathogen that is typically transmitted via the fecal-oral route. The most common clinical manifestation of a Y. enterocolitica infection is self-limited gastroenteritis. Although various extraintestinal manifestations of Y. enterocolitica infection have been reported, there are no reports of thyroid abscesses. CASE PRESENTATION: An 89-year-old Japanese man with follicular adenoma of the left thyroid gland was admitted to our hospital with a 2-day history of fever and left neck pain. Laboratory tests revealed low levels of thyroid stimulating hormone and elevated levels of free thyroxine 4. Contrast-enhanced computed tomography showed low-attenuation areas with peripheral enhancement in the left thyroid gland. He was diagnosed with thyroid abscess and thyrotoxicosis, and treatment with intravenous piperacillin-tazobactam was initiated after collecting blood, drainage fluid, and stool samples. The isolated Gram-negative rod bacteria from blood and drainage fluid cultures was confirmed to be Y. enterocolitica. He was diagnosed with thyroid abscess and thyrotoxicosis due to be Y. enterocolitica subsp. palearctica. The piperacillin-tazobactam was replaced with levofloxacin. CONCLUSION: We report a novel case of a thyroid abscess associated with thyrotoxicosis caused by Y. enterocolitica subsp. palearctica in a patient with a follicular thyroid adenoma.

Clinical features of a case of brucellosis complicated with thyroid abscess / 中华地方病学杂志

Objective:Clinical characteristics and diagnosis and treatment process was reported and analyzed of a patient with brucellosis complicated with thyroid abscess, providing reference for the clinical diagnosis of brucellosis complicated with thyroid abscess.Methods:Clinical medical records of a patient with brucellosis complicated with thyroid abscess who was treated at the General Surgery Department of Yanchi County People's Hospital in Wuzhong City, Ningxia Hui Autonomous Region in November 2021 were collected. The clinical manifestations, blood routine, brucella antibodies, thyroid function, bacterial culture, thyroid ultrasound and other examination results, as well as the diagnosis and treatment process, were comprehensively analyzed. Results:The patient was a male, 61 years old, who presented with a neck mass without typical clinical manifestations of brucellosis. Thyroid ultrasound revealed a space occupying lesion, and the preliminary diagnosis was thyroid cystadenoma. Thyroid right lobe and isthmus resection surgery was performed. During the operation, it was found that some of the thyroid glands were tightly adhered to the cervical blood vessels, so the resection surgery was changed to abscess drainage, and the drainage fluid was purulent and bloody. The bacterial culture result of thyroid purulent fluid (intraoperative puncture fluid and postoperative drainage fluid) was brucella lamblia, and the serum brucella test tube agglutination test titer was 1 ∶ 400 (+++). The patient improved and was discharged after local drainage and anti brucella treatment. Follow up for 4 months showed no abnormalities. Conclusions:Brucellosis which begins with a local infection of the thyroid gland is extremely rare, with no characteristic clinical manifestations, and is prone to misdiagnosis. Timely correction of the surgical plan during the treatment process avoids the removal of the patient's thyroid, which has a certain clinical reference value.

A Rare Presentation of Thyroid Mass as Tubercular Abscess: A Case Report.

Isolated thyroid gland tuberculosis is a rare disease, while even rarer is its presentation as an acute abscess. Here we present the case of a 65-year-old female who presented with a neck swelling which progressed to an abscess with multiple discharging sinuses which was proven to be tubercular abscess on histopathology.

A Case of Pediatric Thyroid Abscess: A Rare Entity.

Acute Suppurative Thyroiditis (AST) is a rare, but potentially fatal emergency in the pediatric age group. With a mortality of 3.7% to 9% in AST, it is imperative to make a timely diagnosis and start treatment accordingly. In this case report, we discuss a case of thyroid abscess in a six-year-old, which was diagnosed on ultrasonography (USG)(machine: GE logic 9 USG, Milwaukee) and Contrast-Enhanced Computed Tomography (CECT) (machine: 32 slice GE revolution act machine, Milwaukee) of the neck. With this article, we attempt to stress upon the need for quick and accurate diagnosis and timely intervention to prevent complications as the condition is rare and unusual.

A Rare Case of Neck Swelling: Acute Suppurative Thyroiditis With End-Stage Renal Disease.

Acute suppurative thyroiditis is a rare life-threatening endocrine emergency. The thyroid gland has rich vascularity and lymphatic drainage, has large amounts of iodine in the tissue, generates hydrogen peroxide, and is encapsulated. Owing to these factors, infection of the thyroid gland is rare. The clinical presentation of acute suppurative thyroiditis closely resembles that of subacute thyroiditis, with a differentiation possible only on fine needle aspiration cytology (FNAC). However, differentiating these two conditions is important because the management of these two conditions differs drastically. Management includes intravenous antibiotics, drainage of abscesses, and sometimes surgery may be required. Here, we present a case of thyroid abscess caused by methicillin-resistant Staphylococcus aureus (MRSA), diagnosed using FNAC of the thyroid gland and blood culture.

Thyroid Abscess in a Young Postpartum Female.

Due to the characteristics of the thyroid gland that prevent infiltration of pathogens, suppurative thyroid gland infections causing thyroid gland abscess are rarely encountered. Herein, we report a young female who presented to our hospital with pulmonary tuberculosis and Klebsiella pneumonia complicated with empyema. During her admission, she developed a rapidly enlarging and tender thyroid gland that produced respiratory obstructive symptoms. Upon clinical examination and radiological imaging, the diagnosis of thyroid abscess was confirmed. Surgical incision and drainage of the abscess was performed along with proper coverage of antibiotics. Thereafter, the patient's clinical status improved dramatically. Although thyroid gland abscesses are rare in clinical practice, a rapidly enlarging thyroid gland in a patient with overt bacterial infection should raise the suspicion of thyroid abscess. Timely diagnosis and proper management can be life-saving in such cases.

Acute Suppurative Thyroiditis (AST) With Thyroid Abscess: A Rare and Potentially Fatal Neck Infection.

Thyroid abscess, although rare, is a condition that usually occurs as a sequela of acute suppurative thyroiditis (AST) which is an infection of the thyroid gland. The infrequent occurrence of thyroid abscess is due to the unique anatomical and physiological characteristics of the gland which renders it resistant to infections. Delay in diagnosis and treatment can have adverse outcomes and serious complications such as septicaemia, descending necrotising mediastinitis, extension into deep spaces of the neck, and tracheal or oesophageal perforation. The mainstay of management is a combination of systemic antibiotics along with incision and drainage, and rarely surgery. We report the case of a 37-year-old male with acute suppurative thyroiditis with a thyroid abscess. He underwent incision and drainage of the abscess and was subsequently treated with systemic antibiotics. This condition warrants a prompt and timely diagnosis with appropriate management as it often leads to fatal complications if not diagnosed early.

Lessons of the month 1: A diagnostic dilemma: thyroid abscess or subacute thyroiditis?

Thyroid abscess is rare but potentially fatal, whereas subclinical thyroiditis is a self-limiting condition that is more commonly seen. The clinical features of both diseases can be overlapping but the treatment approach differs. We report a case of a painful left thyroid nodule not responding to conventional therapy for thyroiditis or thyroid abscess.

Advanced hypopharyngeal squamous cell carcinoma mimicking thyroid abscess in a young male: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Thyroid gland involvement by hypopharyngeal carcinoma is due to their close proximity. Initial presentation of such cancer as a thyroid abscess is rare in clinical practice thus risk of potential misdiagnosis. To the best of our knowledge, this is the first reported case in Tanzania. CASE PRESENTATION: We present a 17-year old male who presented with difficulty in swallowing, hot potato voice, difficulty in breathing and a wound at the anterior aspect of the neck. He was managed at peripheral health facilities as having thyroid abscess so had serial incision and drainage and prescribed antibiotics. He was referred to us where he undergone tracheostomy, direct laryngoscopy coupled with taking biopsy. CLINICAL DISCUSSION: Computerized tomography (CT scan) of the head and neck showed an ill-defined heterogeneously enhancing mass with calcifications seen at the hypopharynx extending to the larynx and thyroid gland causing destruction of cricoid cartilage. It measured approximately 7.6 × 6.5 × 4.4 cm. The submandibular and sublingual glands are slightly infiltrated. Multiple enlarged lymph nodes are seen at anterior upper jugular IIa and posterior upper jugular IIb with the largest having central necrosis and measures approximately 2.9 × 1.7 cm. Histopathology showed an ulcerated epithelium with an infiltrative tumor containing dense chromatin. Such features were consistent with invasive squamous cell carcinoma, Grade II.(TNM staging being T4bN2cM0). The patient undergone tracheostomy to relieve upper airway obstruction and sent to oncology center for chemoradiation. CONCLUSION: Clinicians should have a high index of suspicion of a possible underlying hypopharyngeal cancer whenever encountering patients with thyroid abscess.

Thyroid Abscess as a Clinical Manifestation of Papillary Thyroid Carcinoma.

Even in immunocompromised patients, thyroid abscess is a rare occurrence. One factor that predisposes the thyroid gland to infection is pre-existing diseases such as thyroid nodule or thyroid cancer. A mass usually accompanies thyroid cancer. On the other hand, thyroid cancer is uncommon to present with a thyroid cyst or abscess, even as infection symptoms. In this article, we presented a 50-year-old woman who suffered from a thyroid abscess. She had been diagnosed with an untreated thyroid nodule a year prior and presenting with an enlarged, painful, and warm neck mass accompanied with fever, and dysphagia for 7 days. Treatment began with intravenous antibiotic and percutaneous drainage with intracavitary antibiotic injection. The culture contained no organism. Isthmolobectomy was performed due to expanding abscess to the surrounding tissue, and the histopathology examination confirmed thyroid abscess with a follicular variant of papillary thyroid carcinoma.

Acute Suppurative Thyroiditis Secondary to Escherichia coli Infection.

Infections of the thyroid gland are rare. Its innate resistance to infections can be attributed to its unique anatomical features and rich blood supply. High clinical suspicion is required as a delay in diagnosis can lead to significant morbidity and mortality. Major pathogens include the Gram-positive Staphylococcus aureus and Streptococcus species; however, Gram-negative organisms have been found especially in immunocompromised hosts. We present a rare case of acute suppurative thyroiditis (AST) secondary to Escherichia coli (E. coli) infection in a woman known to be infected with human immunodeficiency virus (HIV). LEARNING POINTS: Thyroid abscesses are rare and can be confused with more common pathologies involving the neck such as a goitre, adenoma, intracystic haemorrhage, pharyngeal abscess and subacute thyroiditis.A high index of suspicion for a thyroid abscess is required for patients who present with an anterior neck swelling to avoid a late diagnosis, which is associated with significant morbidity and mortality.Acute suppurative thyroiditis is more commonly caused by Gram-positive organisms. Gram-negative organisms such as E. coli remain a rare cause. However, if a thyroid abscess is suspected clinically, broad-spectrum antibiotics can be lifesaving before definite culture and sensitivity results are available.