Acute suppurative thyroiditis with Graves disease - A very rare association

Area of Science:

• Endocrinology
• Infectious Diseases
• Otolaryngology

Background:

• Acute suppurative thyroiditis is a rare bacterial infection of the thyroid gland, often presenting without thyroid dysfunction.
• Foreign body ingestion, such as fish bones, can rarely lead to thyroid abscess formation.
• Graves disease is an autoimmune disorder causing hyperthyroidism.

Observation:

• A 62-year-old female presented with a painful neck mass and difficulty swallowing after a fish bone removal.
• Physical examination revealed a tender thyroid mass, fever, and tachycardia.
• Laboratory tests showed suppressed thyroid-stimulating hormone (TSH), elevated free thyroxine (FT4), and positive anti-TSH receptor antibodies (TRABs), indicative of thyrotoxicosis and suggestive of Graves disease.
• Cervical ultrasonography identified a left thyroid lobe abscess, and fine needle aspiration biopsy (FNAB) isolated Staphylococcus aureus and Streptococcus viridans.

Findings:

• The patient received targeted antibiotic therapy and drainage, leading to clinical improvement and reduced inflammatory markers.
• Persistent thyrotoxicosis necessitated treatment with thiamazole post-discharge.
• Complete resolution of the thyroid abscess and normalization of thyroid function were achieved within six months to one year.

Implications:

• This case represents the third reported association between acute thyroiditis and Graves disease.
• It is the first documented instance of acute suppurative thyroiditis, caused by a foreign body, occurring simultaneously with Graves disease.
• This case underscores the importance of considering diverse etiologies and co-existing conditions in complex thyroid presentations.