Endocrine Abstracts

JOINT2842

Introduction: Thyroid abscess is a rare condition that constitutes 0.1-0.7% of all thyroid diseases, usually occurring as a result of acute suppurative thyroiditis (AST), which is an infection of the thyroid gland. The rich blood supply of the thyroid gland, extensive lymphatic drainage, high iodine content, have a protective function against infections.

Case: An 18-year-old male patient presented to the emergency service with complaints of gradually increasing swelling, redness, and pain in the neck for approximately 2 weeks. He had no chronic disease and was not using any medication. Upon palpation of the patient’s neck, a painful swelling was detected, and an USG was performed, which revealed a hypodense lesion compatible with an abscess, with lobulated contours of 57x50 mm in size in the midline of the neck. A neck CT was requested for additional pathology, which revealed an abscess within the thyroid parenchyma. Purulent fluid was obtained from the lesion in the emergency by fine needle aspiration, which was confirmed, and a sample was sent for culture and direct examination. Later, incision and abscess drainage were performed. Laboratory values were TSH: 10 (0.27-4.2 µIU/ml), CRP: 85 (0-5 mg/l), ALT: 455 (0-40 U/l), AST: 41 (10-41 U/l), WBC: 24.06×10³/μL (%74 neutrophil), anti-TPO and anti-thyroglobulin antibodies negative, other values were normal. The patient was started on antibiotherapy (ampicillin sulbactam and metronidazole) with drainage. Viral hepatitis markers were negative. Immunoglobulin (IgG, IgA, IgM) values were normal. Gram positive and gram negative bacteria were seen in the abscess culture, but anaerobic bacteria were considered as the possible agent due to the absence of growth in the aerobic culture. The patient, whose symptoms and infection parameters regressed with treatment, was taken under follow-up.

Conclusion: Adult patients with AST usually have evidence of Hashimoto’s thyroiditis or thyroid malignancy. Children with congenital anatomical anomalies such as branchial arch anomaly are at increased risk for AST. In our case, anomaly was investigated due to being in late adolescence, but no pathology was detected. Clinically, fever, neck swelling, sore throat, and difficulty swallowing are present as in our case. Rarely, thyrotoxicosis secondary to destruction can occur. In most cases, the predominant cause among bacterial etiology is Staphylococcus aureus. Treatment includes systemic antibiotic therapy with drainage. Recurrence of the abscess, worsening of symptoms, widespread necrosis may require lobectomy. As a result, although rare, AST and thyroid abscess are possible even in immunocompetent patients without congenital anomaly and thyroid disorder