Raman Lavanya, Murray James, Banka Rajesh
Department of Respiratory, King George Hospital, London, UK.
BMJ Case Rep. 2014 Feb 27;2014:bcr2013202792. doi: 10.1136/bcr-2013-202792.
We describe a 38-year-old Indian man who presented with a 2-week history of fever, night sweats and neck swelling who was found to be clinically thyrotoxic with a nodular goitre, tachycardia and high fever. Biochemical investigation revealed hyperthyroidism in association with deranged liver function tests and raised inflammatory markers. Ultrasound and CT scans of the neck revealed multinodular thyroid enlargement. He was considered most likely to have an acute infectious thyroiditis with a differential diagnosis of a toxic multinodular goitre and was started on carbimazole and antibiotics. He underwent fine needle aspiration of the thyroid which revealed necrotic cells and acid-fast bacilli, confirming a diagnosis of primary tuberculosis (TB) of the thyroid gland with no evidence of any other organ involvement on systemic imaging. He was started on TB therapy for 6 months and discharged with outpatient follow-up. Symptoms and biochemical markers subsequently resolved.
我们描述了一名38岁的印度男性，他有2周的发热、盗汗和颈部肿胀病史，临床检查发现患有甲状腺毒症，伴有结节性甲状腺肿、心动过速和高热。生化检查显示甲状腺功能亢进，同时肝功能检查异常且炎症标志物升高。颈部超声和CT扫描显示甲状腺多结节性肿大。他被认为最有可能患有急性感染性甲状腺炎，鉴别诊断为毒性多结节性甲状腺肿，并开始服用卡比马唑和抗生素。他接受了甲状腺细针穿刺，结果显示有坏死细胞和抗酸杆菌，确诊为甲状腺原发性结核，全身影像学检查未发现其他器官受累的证据。他开始接受为期6个月的抗结核治疗，出院后进行门诊随访。症状和生化指标随后得到缓解。
