|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 3 | Page : 125-126
Missed thyroid abscess
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
|Date of Web Publication||16-Oct-2015|
Dr. Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Aliyu I. Missed thyroid abscess. Thyroid Res Pract 2015;12:125-6
After reading the recent article on thyroid abscess by Nirhale et al.,  this communication seeks to further highlight an unusual presentation that may be associated with it. It is a rare disease because of the peculiarities of the thyroid glands-such as its complete encapsulation, rich lymphatic and blood supplies, and high iodine content-which protect it from bacterial infection.  However, it is commoner in immune-deficient patients,  and those with anatomical defect such as a pyriform sinus are predisposed to it. , Furthermore, females are more affected than males. In this instance, the index case was a 4-year-old boy who had cough, catarrh, sore throat, and fever; the parents believed the symptoms were of flu and treated the child with paracetamol and antibiotic (amoxicillin) based on self-prescription. The patient got better and the fever subsided. However, 3 days later, the parents noticed a swelling on the anterior neck with mild discomfort, warranting their presentation to the hospital. At this point, he was afebrile, active, and the throat examination was not remarkable. There was a swelling at the anterior neck, the left side more affected than the right, measuring 2 × 1 cm, which moved with swallowing and was mildly tender. Other physical examinations were not remarkable. Therefore, the patient was diagnosed with euthyroid goiter. The thyroid function test was requested on an outpatient basis, and the antibiotic was discontinued. During a follow-up visit 2 days later, it was noticed that the swelling had increased, measuring 3 × 2 cm, with marked tenderness; it was shiny and the thyroid function test was normal. Based on the new findings, the patient was diagnosed with thyroid abscess. About 5 ml of pus was drained; the sample was sent for culture, but yielded no growth. However, he was treated with parenteral ampicillin and cloxacillin; he improved remarkably and was discharged 12 days later.
Thyroid abscess is rare; therefore, it may not be a common differential diagnosis of neck swelling in children, especially when features of infection such as fever, lassitude and loss of appetite are absent- as was observed in the index case. The absence of fever was attributed to the antipyretic he had combined with the antibiotic which might have suppressed a worsening clinical manifestation at the initial presentation. However, the mild neck discomfort and tenderness which was overlooked by both the parents and the physician could have been the pointer to the possibility of an inflammatory process considering his history of fever; the use of antibiotic and analgesic may have ameliorated the clinical course. Therefore, high index of suspicion of thyroiditis is essential in a child with an acute thyroid disorder presenting with tenderness, especially when there are no clinical evidence of hypo- or hyperthyroidism, because this could progress to abscess formation if not properly treated. Furthermore, medications given may alter the clinical presentation, as was seen in the index case. Common organisms implicated are Staphylococcus aureus and Streptococcus pneumonia, but Gram-negatives like Klebsiella pneumoniae have also been isolated. However, in the index case, the culture was negative, which may be attributed to prior commencement of an antibiotic to the child before initial presentation.
| References|| |
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