Acute Suppurative Thyroiditis Progressing to a Thyroid Abscess

Patient Information:
A 67-year-old female presented with a painful anterior neck swelling lasting for one week. Her past medical history was notable for diabetes, but family, surgical, and drug histories were unremarkable.

Clinical Findings:
The only significant clinical finding was tenderness over the anterior aspect of the neck.

Diagnostic Assessment:
Laboratory investigations revealed anemia (Hemoglobin 8.0 g/dl), low hematocrit (23.8%), and elevated white blood cells (11.5 x 10^9 cells/cm²). Antero-posterior and lateral cervical X-rays showed a large lesion in the right side of the neck, which displaced the trachea to the left. Multinodular goiter was suspected. On ultrasound examination, the right thyroid lobe was found to be enlarged (150 x 75 x 57 mm) due to a complex, thick-walled mass with echogenic shadow. The mass pushed the right common carotid artery laterally and compressed the trachea medially, with retrosternal extension inferiorly. The left thyroid lobe was slightly smaller (95 x 21 x 19 mm) and had two calcified nodules measuring less than 18mm. No cervical lymphadenopathy was noted. CT scan of the neck and upper chest revealed a well-defined collection in the right thyroid lobe, with enhancing margins, measuring 7 x 5 cm. The center of the lesion was necrotic and contained gas. There was also diffuse edema around the right thyroid lobe and a shift in the trachea to the left. Several reactive lymph nodes were noted on the right side, all measuring less than 15 mm. Fine needle aspiration cytology (FNAC) revealed contents of a hemorrhagic cyst (Bethesda I), with air being expelled during aspiration. Preoperative laboratory findings included an elevated ESR (>140 mm/hr), CRP (238.50 mg/L), HbA1C (12.5%), random blood sugar (184.2 mg/dl), serum ferritin (1135 ng/ml), and D-Dimer (0.64 μg/dl).

Therapeutic Intervention:
The patient underwent a right thyroid lobectomy, and histopathological examination confirmed the presence of a thyroid abscess without malignancy.

Follow-Up:
The patient was discharged from the hospital on the first postoperative day without complications. Six months later, the patient remained free from recurrence.

Image Gallery