Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal.
Serviço de Endocrinologia, Hospital de Braga, Braga, Portugal,
Arch Endocrinol Metab. 2023 May 25;67(5):e000610. doi: 10.20945/2359-3997000000610.
Acute suppurative thyroiditis is an uncommon disorder caused by a bacterial infection, usually presenting with normal thyroid function. It is a serious condition that requires a prompt diagnosis and treatment with antibiotics and supportive measures. A 62 years-old female presented with a painful cervical induration and odynophagia a week after a fish bone had been removed from her pharynx. She was febrile, and tachycardic and, on physical examination, a painful thyroid mass was detected. High inflammatory parameters and thyrotoxicosis were confirmed: thyroid stimulating hormone (TSH) < 0.01 mIU/L (normal range [NR] 0.27-4.2); free thyroxine (FT4) 3.86 ng/dL (NR 0.9-1.7) and anti-TSH receptor antibodies (TRABs) 5.3 U/L (NR < 1.5). Thyroid scintigraphy showed a diffuse uptake of the thyroid parenchyma suggesting Graves disease. Cervical ultrasonography revealed an abscess of the left thyroid lobe of 36 × 36 mm and fine needle aspiration biopsy (FNAB) with partial drainage was performed. and were isolated, and directed antibiotic therapy was started. Clinical improvement was observed as well as a decrease of inflammatory parameters and the patient was discharged after 9 days of hospitalization. Eighteen days after discharge, thiamazole was initiated due to persistent thyrotoxicosis. Complete resolution of the abscess was documented within 6 months and the patient became euthyroid under thiamazole one year after initial presentation. To our knowledge, this is the third case reporting an association between acute thyroiditis and Graves disease. Furthermore, this is the first case detailing the simultaneous diagnosis of acute suppurative thyroiditis caused by a foreign body and Graves disease.
急性化脓性甲状腺炎是一种由细菌感染引起的罕见疾病，通常表现为甲状腺功能正常。这是一种严重的疾病，需要及时诊断和治疗，包括使用抗生素和支持性措施。一位 62 岁女性在咽部取出鱼刺后一周出现颈部疼痛性硬结和吞咽困难，伴有发热和心动过速。体格检查发现甲状腺疼痛性肿块。高炎症参数和甲状腺毒症得到证实：促甲状腺激素（TSH）<0.01 mIU/L（正常范围[NR] 0.27-4.2）；游离甲状腺素（FT4）3.86ng/dL（NR 0.9-1.7）和抗促甲状腺激素受体抗体（TRABs）5.3 U/L（NR <1.5）。甲状腺闪烁显像显示甲状腺实质弥漫摄取，提示 Graves 病。颈部超声显示左甲状腺叶脓肿大小为 36×36mm，行细针抽吸活检（FNAB）并部分引流。和 被分离出来，并开始使用靶向抗生素治疗。临床症状改善，炎症参数下降，患者在住院 9 天后出院。出院后 18 天，由于持续的甲状腺毒症，开始使用甲巯咪唑。6 个月内完全消退脓肿，患者在初次就诊一年后甲状腺功能正常。据我们所知，这是第三例报告急性甲状腺炎和 Graves 病之间存在关联的病例。此外，这是首例详细报告由异物引起的急性化脓性甲状腺炎和 Graves 病同时诊断的病例。
