Acute suppurative thyroiditis is a very uncommon disorder, most often arising in children with congenital conditions connecting the thyroid directly to the oropharynx, such as a piriform
fistula or thyroglossal duct. Accordingly, the most common causative agents are those which can colonize the oral mucosa and spread to the thyroid contiguously, such as Streptococcus species, Staphylococcus species and anerobes. In adults, a hematogenous spread to a pre-existing altered thyroid gland is often the postulated pathogenetic mechanism, and it is exceedingly rare in the United States. We report the case of an 81-yr-old woman with
acute suppurative thyroiditis secondary to Escherichia coli (E. coli)
infection. The patient presented with
fevers,
chills,
dysuria and recent painful neck swelling. Thyroid ultrasound and neck computed tomography revealed a multinodular
goiter and an intra-thyroid
abscess. An otolaryngology evaluation and
barium swallow failed to show a piriform
fistula.
Thyroid hormone levels were consistent with
hyperthyroidism. Urine cultures were positive for E. coli. The patient subsequently developed a clinical picture consistent with severe
thyrotoxicosis, which rapidly resolved after medical treatment, appropriate
antibiotics and surgical drainage of the thyroid.
Abscess material also grew E. coli. Thus,
acute suppurative thyroiditis secondary to
sepsis can complicate an otherwise asymptomatic multinodular
goiter and should be promptly treated with broad-spectrum
antibiotics and/or surgical drainage to avoid serious consequences, including severe
thyrotoxicosis.