Endocrine Abstracts

JOINT1332

Introduction: According to the WHO, Cameroon located in Central Africa, is ranked among the 30 high Tuberculosis (TB) burden countries in the world. Moreover, in 2021, more than 22000 people were infected with TB and 5.1% of cases concerned children aged 0-14 years. Thyroid nodules in children are rare and usually benign. However, in regions where TB is endemic, rarer causes like tuberculous thyroiditis must be considered. This condition accounting for less than 1% of extra-pulmonary TB can present as a painless nodule and may be misdiagnosed as a benign abscess or adenoma. Diagnosis is often delayed requiring a combination of clinical, laboratory and histopathological findings. This case highlights the diagnostic challenges and the need for a high index of suspicion for TB in pediatric thyroid nodules.

Case Presentation: A 4-year old boy was referred for endocrine consultation before planned thyroid surgery due to a year long history of neck pain and an enlarged thyroid. Initial tests showed no signs of thyroid dysfunction but a high WBC count (26.675x10⁹/l with neutrophil predominance of 84%). Thyroid abscess was suspected and was treated with antibiotics. Symptoms recurred with pain and after stronger antibiotics failed, fistulization occurred prompting surgery. FNA was refused and a CT scan revealed a nodule. Further questioning revealed the mother had chronic cough, weight loss and night sweats raising concern for tuberculosis. Her sputum was positive for Mycobacterium tuberculosis leading to suspicion of tuberculous thyroiditis in the child. A chest X-ray and gastric lavage for Mycobacterium tuberculosis testing were both negative in the child. Empirical antiTB treatment was initiated with favorable response and the child remained well at 1year follow-up.

Discussion: Symptoms including enlarging nodules, neck pain, fever, weight loss may mimic other thyroid conditions delaying diagnosis. In this case, failure to respond to antibiotics, symptom recurrence, mother’s history and a positive sputum culture for Mycobacterium tuberculosis prompted consideration of tuberculous thyroiditis. Fistulization further suggested TB. In paediatric patients a thorough history including exposure to adults with active pulmonary TB is crucial for making the diagnosis and in many cases, surgical intervention is not required once the underlying TB infection is effectively treated. The diagnosis requires high clinical suspicion and while FNA is the gold standard.

Conclusion: Tuberculous thyroiditis, though rare, should be considered in pediatric thyroid nodules especially in TB endemic areas. This case highlights the importance of a detailed patient history including potential TB exposure.