Coincident Suppurative Thyroiditis and Graves Disease in a Patient with Infected Branchial Cleft CYST
ABSTRACT: Objective: Acute suppurative thyroiditis (AST) is frequently caused by anatomic abnormalities, including branchial cleft cysts. Patients with AST are typically euthyroid, but thyrotoxicosis may occur. Thyroid antibodies are usually not present in AST. Our objective is to describe a teenag...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-11-01
|
| Series: | AACE Clinical Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2376060520300390 |
| _version_ | 1818723067195555840 |
|---|---|
| author | Ugen Lhamu, MD Ari J. Wassner, MD Lisa Swartz Topor, MD, MMS |
| author_facet | Ugen Lhamu, MD Ari J. Wassner, MD Lisa Swartz Topor, MD, MMS |
| author_sort | Ugen Lhamu, MD |
| collection | DOAJ |
| description | ABSTRACT: Objective: Acute suppurative thyroiditis (AST) is frequently caused by anatomic abnormalities, including branchial cleft cysts. Patients with AST are typically euthyroid, but thyrotoxicosis may occur. Thyroid antibodies are usually not present in AST. Our objective is to describe a teenage male who presented with concomitant suppurative thyroiditis and Graves disease (GD). Methods: We report a case of an infected left branchial cleft cyst with AST and concurrent GD in an adolescent male. Thyroid function tests and thyroid imaging were used for diagnostic evaluation, and the patient was managed with antibiotics, analgesia, and surgery. Results: A 17-year-old male with a history of an infected left fourth branchial cleft cyst presented with recurrence of neck pain, odynophagia, and fever. Serum labs showed thyrotoxicosis and elevated thyroid antibodies and inflammatory markers. Magnetic resonance imaging showed an abscess adjacent to the left thyroid lobe. Symptoms resolved after antibiotic therapy, but laboratory tests showed persistent subclinical thyrotoxicosis. Four months later, he underwent excision of the branchial cleft cyst and left thyroid lobe. Two months after surgery, evaluation showed overt thyrotoxicosis with laboratory tests confirming GD. Methimazole was initiated and thyroid function subsequently normalized. Conclusion: This patient manifested a rare coincidence of AST due to a branchial cleft cyst and autoimmune thyroid disease. Further studies are needed to determine if there is any relationship between AST and development of thyroid autoimmunity. Assessment of thyroid autoimmunity may be considered in patients with prior or recurrent AST. |
| first_indexed | 2024-12-17T21:04:37Z |
| format | Article |
| id | doaj.art-959f3658b90d4a119ac691ece4a04701 |
| institution | Directory Open Access Journal |
| issn | 2376-0605 |
| language | English |
| last_indexed | 2024-12-17T21:04:37Z |
| publishDate | 2019-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AACE Clinical Case Reports |
| spelling | doaj.art-959f3658b90d4a119ac691ece4a047012022-12-21T21:32:38ZengElsevierAACE Clinical Case Reports2376-06052019-11-0156e365e368Coincident Suppurative Thyroiditis and Graves Disease in a Patient with Infected Branchial Cleft CYSTUgen Lhamu, MD0Ari J. Wassner, MD1Lisa Swartz Topor, MD, MMS2From the Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, Rhode Island; Warren Alpert Medical School of Brown University, Providence, Rhode IslandDivision of Endocrinology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.Address correspondence to Dr. Lisa Swartz Topor, 111 Plain Street, Providence, RI 02903.; From the Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, Rhode Island; Warren Alpert Medical School of Brown University, Providence, Rhode IslandABSTRACT: Objective: Acute suppurative thyroiditis (AST) is frequently caused by anatomic abnormalities, including branchial cleft cysts. Patients with AST are typically euthyroid, but thyrotoxicosis may occur. Thyroid antibodies are usually not present in AST. Our objective is to describe a teenage male who presented with concomitant suppurative thyroiditis and Graves disease (GD). Methods: We report a case of an infected left branchial cleft cyst with AST and concurrent GD in an adolescent male. Thyroid function tests and thyroid imaging were used for diagnostic evaluation, and the patient was managed with antibiotics, analgesia, and surgery. Results: A 17-year-old male with a history of an infected left fourth branchial cleft cyst presented with recurrence of neck pain, odynophagia, and fever. Serum labs showed thyrotoxicosis and elevated thyroid antibodies and inflammatory markers. Magnetic resonance imaging showed an abscess adjacent to the left thyroid lobe. Symptoms resolved after antibiotic therapy, but laboratory tests showed persistent subclinical thyrotoxicosis. Four months later, he underwent excision of the branchial cleft cyst and left thyroid lobe. Two months after surgery, evaluation showed overt thyrotoxicosis with laboratory tests confirming GD. Methimazole was initiated and thyroid function subsequently normalized. Conclusion: This patient manifested a rare coincidence of AST due to a branchial cleft cyst and autoimmune thyroid disease. Further studies are needed to determine if there is any relationship between AST and development of thyroid autoimmunity. Assessment of thyroid autoimmunity may be considered in patients with prior or recurrent AST.http://www.sciencedirect.com/science/article/pii/S2376060520300390 |
| spellingShingle | Ugen Lhamu, MD Ari J. Wassner, MD Lisa Swartz Topor, MD, MMS Coincident Suppurative Thyroiditis and Graves Disease in a Patient with Infected Branchial Cleft CYST AACE Clinical Case Reports |
| title | Coincident Suppurative Thyroiditis and Graves Disease in a Patient with Infected Branchial Cleft CYST |
| title_full | Coincident Suppurative Thyroiditis and Graves Disease in a Patient with Infected Branchial Cleft CYST |
| title_fullStr | Coincident Suppurative Thyroiditis and Graves Disease in a Patient with Infected Branchial Cleft CYST |
| title_full_unstemmed | Coincident Suppurative Thyroiditis and Graves Disease in a Patient with Infected Branchial Cleft CYST |
| title_short | Coincident Suppurative Thyroiditis and Graves Disease in a Patient with Infected Branchial Cleft CYST |
| title_sort | coincident suppurative thyroiditis and graves disease in a patient with infected branchial cleft cyst |
| url | http://www.sciencedirect.com/science/article/pii/S2376060520300390 |
| work_keys_str_mv | AT ugenlhamumd coincidentsuppurativethyroiditisandgravesdiseaseinapatientwithinfectedbranchialcleftcyst AT arijwassnermd coincidentsuppurativethyroiditisandgravesdiseaseinapatientwithinfectedbranchialcleftcyst AT lisaswartztopormdmms coincidentsuppurativethyroiditisandgravesdiseaseinapatientwithinfectedbranchialcleftcyst |