A Rare Case of Thyroid Abscess Associated with Thyrotoxicosis in a Child

Case Report

J Pediatri Endocrinol. 2017; 2(2): 1021.

A Rare Case of Thyroid Abscess Associated with Thyrotoxicosis in a Child

Puthiyachirakkal M*, Sanalkumarn and Persaudr

Departments of Pediatrics, Endocrinology and ENT, A1 Zahra Hospital, United Arab Emirates

*Corresponding author: Mohammed Ashraf Puthiyachirakkal, Departments of Pediatrics, Endocrinology and ENT, Al Zahra Hospital, United Arab Emirates

Received: November 28, 2017; Accepted: December 22, 2017; Published: December 29, 2017


Thyroid abscess associated with thyrotoxicosis is a rare condition in children. This is because the thyroid gland is relatively resistant to infection because of its high blood supply, thick fibrous capsule and its high iodine ontent. We present a unique case of a thyroid abscess caused by Eikenella Corrodens in a 3 year 4 month old boy. He had severe anemia, thrombocytosis and thyrotoxicosis. He was treated with antibiotics, atenolol, steroid and incision and drainage. He recovered completely without any complication. This potentially life threatening complication of thyroid gland infection, if treated promptly may recover without any sequel. These patients should be followed up to monitor the thyroid function for the subsequent development of hypothyroidism due to massive destruction of the gland.

Keywords: Suppurative Thyroiditis thyroid abscess; Eikenella corrodens; Thyrotoxicosis


Acute Suppurative Thyroiditis (AST) resulting from bacterial infection is rare in children, but it’s a potentially life threatening disease because of its close proximity to the trachea [1]. The diagnosis of AST is often delayed due to rarity of the condition [2]. The incidence of AST and thyroid abscess is estimated be 0.1-0.7% of surgically treated thyroid pathologies [2], if left untreated AST may result in 12% of higher mortality [3]. We report a case of thyroid abscess in a young child who was presented with fever of 2 weeks duration.

Case Report

A 3 year 4 month old male child was admitted with the complaints of fever of 14 days, cough and neck swelling for 3 days duration. He was seen in emergency department 10 days prior, for fever and cough and received antipyretics and antibiotics for 5 days. The neck swelling was noticed 3 days before admission which was gradually progressing. The cough was nonproductive and had noisy breathing noticed a day prior to the admission. No history of recurrent infections in the past or contact with tuberculosis. No history of travel outside the country. Past history was significant for eczema and few episodes of wheezing. Immunization was up to date. On physical examination, he was thin built, he weighed 11.35 kg (<5th canticle) with a height of 94 cm (25th canticle). The vitals showed temperature of 38.3°C, pulse rate 110/minute, respiratory rate 30/minute without any distress and Oxygen saturation of 97%. A firm and tender swelling of size 5 cm x 6 cm was noticed in the neck on the left side of trachea below the cricoids which moved upon swallowing. No redness over the swelling was noted. There were 2 cervical nodes of 0.5 cm each on both sides of the neck in the posterior cervical region. Throat was normal. The chest had conducted sounds and examinations of other systems were within normal limits (Table 1). The ultrasound (USG) neck (Figure 1) showed cystic swelling of size 3.2 cm x 2.2 cm x 2 cm, with thick capsule in the left lobe and isthmus of thyroid. The chest was normal except for tracheal deviation to right. CT scan (Figures 2 & 3) showed large cystic swelling involving left lobe, isthmus and part of superior pole of right thyroid gland. Technetium 99 thyroid isotope scan showed very low uptake in the thyroid gland, consistent with destructive thyroiditis. The child was started oceftriaxone and vancomycin and Metronidazole. The child was started on oceftriaxone, vancomycin and Metronidazole. Atenolol was started for mild tachycardia. The patient received dexamethasone injection for tracheal compression, which was later changed to oral prednisolone for quick control of thyrotoxicosis. Low dose aspirin was started for very high platelet count. The fever subsided after 1 day of antibiotic treatment, but thyroid USG repeated after 5 days of antibiotics showed slightly increased collection of pus. So, decision was made to do surgical drainage under general anesthesia. The patient received PRBC transfusion before the procedure. 10 ml of pus was removed by incision and drainage. A drain was inserted during the procedure which was removed 2 days later. The culture of the fluid grew Eikenella Corrodens, sensitive to oceftriaxone. The patient improved symptomatically and antibiotics were discontinued and the patient was discharged 3 days after the procedure. Steroids were tapered and stopped 1 week post discharge. The child was reviewed 1 week later and was clinically well. The Repeat CBC showed normal WBC, Hb 10.5 g/dl, platelets 507 x109/L, ESR-22 mm/hr, CRP- 0.5 mg/L. The repeat free T4 was normal 13.4 p mol/L, free T3- 5.45 pmol/L and TSH- 1.86 m IU/L