Thyroid Research and Practice

LETTER TO THE EDITOR
Year
: 2015  |  Volume : 12  |  Issue : 3  |  Page : 125--126

Missed thyroid abscess


Ibrahim Aliyu 
 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria

Correspondence Address:
Dr. Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Nigeria




How to cite this article:
Aliyu I. Missed thyroid abscess.Thyroid Res Pract 2015;12:125-126


How to cite this URL:
Aliyu I. Missed thyroid abscess. Thyroid Res Pract [serial online] 2015 [cited 2021 Oct 16 ];12:125-126
Available from: https://www.thetrp.net/text.asp?2015/12/3/125/157922


Full Text

Sir,

After reading the recent article on thyroid abscess by Nirhale et al., [1] this communication seeks to further highlight an unusual presentation that may be associated with it. It is a rare disease because of the peculiarities of the thyroid glands-such as its complete encapsulation, rich lymphatic and blood supplies, and high iodine content-which protect it from bacterial infection. [2] However, it is commoner in immune-deficient patients, [3] and those with anatomical defect such as a pyriform sinus are predisposed to it. [4],[5] Furthermore, females are more affected than males. In this instance, the index case was a 4-year-old boy who had cough, catarrh, sore throat, and fever; the parents believed the symptoms were of flu and treated the child with paracetamol and antibiotic (amoxicillin) based on self-prescription. The patient got better and the fever subsided. However, 3 days later, the parents noticed a swelling on the anterior neck with mild discomfort, warranting their presentation to the hospital. At this point, he was afebrile, active, and the throat examination was not remarkable. There was a swelling at the anterior neck, the left side more affected than the right, measuring 2 × 1 cm, which moved with swallowing and was mildly tender. Other physical examinations were not remarkable. Therefore, the patient was diagnosed with euthyroid goiter. The thyroid function test was requested on an outpatient basis, and the antibiotic was discontinued. During a follow-up visit 2 days later, it was noticed that the swelling had increased, measuring 3 × 2 cm, with marked tenderness; it was shiny and the thyroid function test was normal. Based on the new findings, the patient was diagnosed with thyroid abscess. About 5 ml of pus was drained; the sample was sent for culture, but yielded no growth. However, he was treated with parenteral ampicillin and cloxacillin; he improved remarkably and was discharged 12 days later.

Thyroid abscess is rare; therefore, it may not be a common differential diagnosis of neck swelling in children, especially when features of infection such as fever, lassitude and loss of appetite are absent- as was observed in the index case. The absence of fever was attributed to the antipyretic he had combined with the antibiotic which might have suppressed a worsening clinical manifestation at the initial presentation. However, the mild neck discomfort and tenderness which was overlooked by both the parents and the physician could have been the pointer to the possibility of an inflammatory process considering his history of fever; the use of antibiotic and analgesic may have ameliorated the clinical course. Therefore, high index of suspicion of thyroiditis is essential in a child with an acute thyroid disorder presenting with tenderness, especially when there are no clinical evidence of hypo- or hyperthyroidism, because this could progress to abscess formation if not properly treated. Furthermore, medications given may alter the clinical presentation, as was seen in the index case. Common organisms implicated are Staphylococcus aureus and Streptococcus pneumonia, but Gram-negatives like Klebsiella pneumoniae have also been isolated. However, in the index case, the culture was negative, which may be attributed to prior commencement of an antibiotic to the child before initial presentation.

References

1Nirhale D, Athayale V, Goenka G, Bhatia M. Thyroid abscess: A rare entity? Thyroid Res Pract 2014;11:131-2.
2Tien KJ, Chen TC, Hsieh MC, Hsu SC, Hsiao JY, Shin SJ, et al. Acute suppurative thyroiditis with deep neck infection: A case report. Thyroid 2007;17:467-9.
3Golshan MM, McHenry CR, de Vente J, Kalajyian RC, Hsu RM, Tomashefski JF. Acute suppurative thyroiditis and necrosis of the thyroid gland: A rare endocrine manifestation of acquired immunodeficiency syndrome. Surgery 1997;121:593-6.
4Smith SL, Pereira KD. Suppurative thyroiditis in children: A management algorithm. Pediatr Emerg Care 2008;24:764-7.
5Schneider U, Birnbacher R, Schick S, Ponhold W, Schober E. Recurrent suppurative thyroiditis due to pyriform sinus fistula: A case report. Eur J Pediatr 1995;154:640-2.