Thyroid abscess is a rare condition because of the thyroid gland anatomical and biochemical nature. We report a rare case of a rapidly developed thyroid abscess in the background of follicular thyroid nodule.
A 77 years old lady admitted for elective right thyroidectomy. She had a history of goiter with normal TFTs. FNA cytology revealed Thy3, Hurthle cell neoplasia. The pre-operation CT scan showed right thyroid large nodule with heterogonous enhancement throughout. She has a background of hypertension, diet controlled diabetes and no other immunosuppressant factors. During the pre-operation assessment the patient became acutely unwell, treated for E coli urosepsis and the operation has been delayed. Multiple blood cultures showed no growth. Despite the 7 days of appropriate intravenous treatment the patient remained clinically unwell and septic. Abdominal or pelvic abscess as source of sepsis excluded after a CT scan. A repeat CT neck thorax, 20 days after the first scan, revealed dramatic change of the right thyroid nodule, being highly suspicious for abscess. Percutaneous abscess drainage performed and growth of coliform confirmed after microbiological examination.
In this case, surprisingly there was a delay in development of clinical inflammatory evidence, possibly due to the position of the pre existing nodule and the treatment of the concurrent UTI. Also, the recent reassuring imaging was an additional pitfall in the early diagnosis of such a rare condition. Its vital, thyroid abscess to be highly considered as a source of sepsis especially in cases with predisposing factors (thyroid disease, previous FNA, concurrent infection) even in the absence of clinical evidence. We also, suggest urgent repeat thyroid imaging even if there is available recent imaging excluding inflammatory process.