The authors review the epidemiology, clinical manifestations, diagnosis, and treatment of fungal
thyroiditis cases previously reported in the medical literature. Aspergillus was by far the most common cause of fungal
thyroiditis. Immunocompromised patients, such as those with
leukemia,
lymphoma,
autoimmune diseases, and organ-transplant patients on pharmacological immunosuppression were particularly at risk. Fungal
thyroiditis was diagnosed at autopsy as part of disseminated
infection in a substantial number of patients without clinical manifestations and laboratory evidence of thyroid dysfunction. Local signs and symptoms of
infection were indistinguishable from other
infectious thyroiditis and included
fever,
anterior cervical pain, thyroid enlargement sometimes associated with
dysphagia and
dysphonia, and clinical and laboratory features of transient
hyperthyroidism due to the release of
thyroid hormone from follicular cell damage, followed by residual
hypothyroidism. Antemortem diagnosis of fungal
thyroiditis was made by direct microscopy and culture of a fine-needle aspirate, or/and biopsy in most cases. Since most patients with fungal
thyroiditis had
disseminated fungal infection with delay in diagnosis and treatment, the overall mortality was high.