Acute Suppurative Thyroiditis with Progression to Thyroid and Retropharyngeal Abscesses: A Case Report

Abstract

Acute Suppurative Thyroiditis (AST) is an exceedingly rare cause of thyroid gland infection. Due to its rarity and non-specific presenting symptoms, diagnosis and treatment of AST may be delayed. We report a case of an elderly male who presented with five days history of intermittent fever, sore throat, dysphagia and vomiting. Painless thyroid swelling was only noted during admission. Ultrasound scan (USS) of the neck showed a well-defined lesion occupying the left thyroid lobe and computed tomography (CT) of the neck showed a rim enhancing collection occupying the left thyroid lobe, extending to retropharyngeal and retrotracheal spaces. Pigtail drainage was performed with no clinical improvement, necessitating incision and drainage, where necrotic tissue mixed with pus was drained. Intraoperative tissue culture isolated Enterococcus faecium, and antibiotic therapy was changed following tissue culture sensitivities (IV Augmentin, 1.2 gram, TDS).  This case highlights the importance of early diagnosis of AST particularly in elderly patients with multiple comorbidities, where symptoms may be atypical. Ultrasound and CT scans are important diagnostic modalities in AST and microbiological assessment is crucial in selecting appropriate antibiotics. The choice of type of drainage should be individualized based on disease extension and comorbidities. A multidisciplinary approach is crucial to ensure best treatment outcome.