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Case report | DOI: https://doi.org/10.31579/2692-9759/075
1Resident physician at the department of otorhinolaryngology and head and neck surgery, Ibn Sina university hospital, Mohamed V University, Rabat, Morocco.
2Professor at the department of otorhinolaryngology and head and neck surgery, Ibn Sina university hospital, Mohamed V University, Rabat, Morocco.
*Corresponding Author: Ikrame Boumendil, Resident physician at the department of otorhinolaryngology and head and neck surgery, Ibn Sina university hospital, Mohamed V University, Rabat, Morocco.
Citation: I Boumendil, Hajar a taleb, H Rahim, S Nitassi, A Oujilal, et al. (2021) Thyroid Gland Abscess: Uncommon complication. Journal of Endocrinology and Disorders. 5(3): Doi:10.31579/2640-1045/075
Copyright: © 2021 Ikrame Boumendil. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 19 May 2021 | Accepted: 04 June 2021 | Published: 09 June 2021
Keywords: thyroid abscess; laryngeal carcinoma; imaging; surgery
The thyroid gland is naturally resistant to infectious processes, which explains the rarity of thyroid abscess. It represent about 0.1% of the surgical thyroid pathology. We report in this article a case of thyroid gland abscess in a 61 year-old man who was followed for diabetes and hypothyroidism with poor adherence, who consulted in emergency department for acute neck swelling. CT scan showed a fluid collection of the left thyroid lobe. The patient was operated, and histopathological examination concluded of laryngeal carcinoma associated to thyroid papillary carcinoma.
The thyroid gland is essentially protected from being seeded by infections due to its anatomy. It is surrounded by a capsule, and it has excellent blood supply and lymphatic drainage. The iodine content of the gland also prevents infections [1]. Even among those with impaired immune systems, thyroid abscesses are rare complications of neck infection and suppurative thyroiditis with incidence being less than 1% of all thyroid diseases. It is most commonly caused by gram-positive aerobes, (Staphylococcus aureus), but there are also reports of gram-negative organisms and fungi [2]. Treatment is intravenous antibiotic therapy with drainage and/or thyroid surgery. If untreated it could be fatal [3].
The aim of our study is to report a case of a thyroid abscess, discuss diagnostic circumstances, clinic and therapeutic involvement of this disease.
It is about a 61 year-old man, with a history of 25 pack/year active smoking, who had no underlying thyroid pathology. The patient was presenting a dysphonia associated at inspiratory effort dyspnea for eight months. He consulted in emergency department for acute neck pain and swelling that progress into difficulty swallowing and breathing developed the last five days.
On physical examination, she was noted to be afebrile, tachycardia into 120s, dyspneic. He had a painful, tender anterior neck swelling with inflammatory signs. There were no palpable lymph-nodes.
He was admitted with a suspected infection or malignancy. Fiberscope examination and cervical-thoracic computed tomography were performed and objectified a process of the left vocal cord extended to the three laryngeal stages and invading the left thyroid lobe, the seat of an abscess measuring 6 cm (Fig1).
The blood biochemical investigations revealed: leukocytes 21.13×103/ul, CRP 190mg/L, ESR 50 mm/h, TSH 0.028 mIU/L, T4 thyroxine (T4) 1.77 ng/dl and free tri-iodothyronine (T3) 2.08 ng/dl. Antithyroperoxidase antibodies and thyroglobulin antibodies were negative.
The needle aspiration returned 30 ml of yellowish purulent fluid and bacteriological examination having isolated Klebsiella pneumonae.
After a week of intravenous bi-antibiotic therapy, the patient underwent a total laryngectomy with total thyroidectomy and bilateral neck dissection. The histopathology revealed the association of squamous cell carcinoma of the larynx with thyroid papillary carcinoma and the existence of micro-metastasis of papillary carcinoma. Radio-chemotherapy combined with iratherapy has been indicated.
The 8-month follow-up was marked by the absence of any local or distant recurrence.
Acute infection of the thyroid is a less seen diagnosis, mostly so as the gland is inherently protected. The encapsulation, rich blood and lymphatic supply, and iodine content inside offer the gland protection from being seeded [1].
Thyroid abscess affects children more than adults. In children, the existence of congenital malformations such as thyroid tract fistulas, and 4th endobrachial cleft fistula may predispose to this infection. Whereas in adults, a compromised immune state, especially acquired immunodeficiency syndrome (AIDS), can do the same. History of previous thyroid disease is another risk factor. Infection can occur also from direct extension in the neck region or from inoculation due to direct trauma - either iatrogenically, in the case of fine-needle aspiration, or from penetration through the oesophagus or skin [2]. In our patient, the existence of laryngeal and thyroidien carcinoma was the predisposing factors for this rare pathology.
Major pathogens are Staphylococcus and Streptococcus species about 35% to 40% of the time. Gram-negative organisms cause about 25
Although these are infrequent conditions, thyroid abscess appears to be gradually rising with the increase of immunosuppressive circumstances. Symptoms are nonspecific and are often combined with the progression of extra-glandular infection and suppuration. Imaging studies play an essential role in their identification, with suspicion of congenital anomalies in young people. The mainstay of this affection management is antibiotic therapy, drainage and in selected cases surgery. The treatment should be started as soon as possible to avoid complications.
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