Acute spontaneous suppurative thyroiditis caused by Eikenella corrodens presented with thyrotoxicosis

ABSTRACT Acute suppurative thyroiditis is a very rare and life-threatening endocrine emergency. Thyrotoxicosis is a rare condition accompanying acute suppurative thyroiditis. While the majority of the cases in the literature are caused by different reasons, spontaneous development is very rare. We present a patient with acute suppurative thyroiditis who presented to our clinic with thyrotoxic findings, and we compared the case to the literature. A 31-year-old male patient was admitted to our clinic with a complaint of progressive neck pain, swelling and redness on midline neck, fever, and palpitations. On physical examination, swelling, redness and tenderness were detected on the neck region that was consistent with the thyroid location. He presented with tremor on the hands, tachycardia and agitation. Thyroid function tests were compatible with thyrotoxicosis, but there were findings supporting the presence of infection in biochemistry tests. On his radiological evaluations, a heterogeneous lesion divided with small septs was observed, with consolidation areas in the left thyroid lobe. In fine needle aspiration biopsy, 2mL of purulent fluid could be aspirated due to the presence of small, separated consolidation areas. He initiated on antibiotic therapy, propranolol, steroid and symptomatic treatment. Eikenella corrodens was detected on the culture antibiogram. Antibiotic therapy was continued for 14 days due to less symptoms and better biochemical values. After treatment, the patient had normal thyroid function, had relief of fever and redness of the neck, and was followed-up. It should be kept in mind that acute suppurative thyroiditis may develop spontaneously with the findings of thyrotoxicosis, with no risk factors.

【摘要】急性化脓性甲状腺炎（acute suppurative thyroiditis）是一种极为罕见且可危及生命的内分泌急症。甲状腺毒症（thyrotoxicosis）是伴随急性化脓性甲状腺炎的罕见病症。尽管文献中多数病例由不同诱因引发，但自发性发病极为罕见。本文报告1例以甲状腺毒症表现就诊于我科的急性化脓性甲状腺炎患者，并将该病例与相关文献进行对比分析。
患者为31岁男性，因渐进性颈痛、颈中线肿胀发红、发热及心悸就诊于我科。体格检查可见甲状腺对应区域颈部存在肿胀、发红及压痛。患者存在手部震颤、心动过速及烦躁不安。甲状腺功能检测结果符合甲状腺毒症表现，但生化检查可见支持感染存在的相关异常指标。影像学检查可见左甲状腺叶存在实变区，可见被细小分隔分割的不均匀病变。细针穿刺活检（fine needle aspiration biopsy）中，因存在多发分隔的实变灶，成功抽吸得到2mL脓性液体。遂予患者抗生素治疗、普萘洛尔、糖皮质激素及对症支持治疗。培养药敏试验检出侵蚀艾肯菌（Eikenella corrodens）。因症状减轻、生化指标改善，抗生素治疗共持续14天。治疗结束后，患者甲状腺功能恢复正常，发热及颈部发红症状缓解，遂纳入随访。需注意，急性化脓性甲状腺炎可无明确危险因素而自发性发病，并伴随甲状腺毒症表现。