A Challenging Case of Thyrotoxicosis and Thyroid Abscess due to Acute Suppurative Thyroiditis

Acute suppurative thyroiditis is a rare but serious condition that can progress to a thyroid abscess, requiring emergency surgical intervention. It is typically caused by Gram-positive bacteria like Staphylococcus or Streptococcus, with mycobacteria or fungi seen in immunocompromised patients.We report a case of a 46-year-old female who presented with neck pain, swelling, palpitations, and malaise. Initial diagnosis was a viral infection, but imaging at our facility revealed a 6 × 5.5 cm abscess in the right thyroid lobe, causing tracheal compression. Labs showed thyrotoxicosis, leukocytosis, and anemia. She was started on β-blockers, PTU, IV steroids, antibiotics, and given a blood transfusion on admission. Her condition worsened, and she underwent neck exploration with drainage of the abscess, revealing E. coli. After treatment, she recovered and was discharged with antibiotics and antithyroid medications. This case emphasizes the importance of early detection and timely surgical intervention of acute suppurative thyroiditis.