Endocrine Abstracts

Incidence of acute thyroiditis is about 0.1% of thyroid gland conditions requiring surgical treatment. Main pathogen causing acute thyroiditis is Staphylococcus aureus while Salmonella enterica is extremely rare.

Herewith we report a 61-year-old obese woman with sore throat and fever. She had chronic atrial fibrillation, hypertension, and well-controlled type 2 diabetes mellitus (HbA1C 5.5%) for 3 years (on metformin and gliclazide). Her medical history was negative for thyroid and renal disorders. Ultrasound examination (US) of the neck demonstrated mixed solid/cystic lesion. Moreover, empirical therapy with clindamycin was introduced (1.2 g/day) and the patient was referred to the endocrinonogy department. On admission she was weakened and dehydrated. Physical examination revealed restricted, swollen, tender and painful lesion in the lower part of the neck. Laboratory tests indicated inflammation, acute kidney injury and hyperthyroidism. Fine-needle aspiration biopsy (FNAB) of the lesion was performed. Cytological diagnosis was consistent with acute thyroiditis, while microbiologically Salmonella enterica was identified as pathogenic factor. Blood and stool cultures were negative for Salmonella. Neck CT revealed thyroid lesion 6.8 cm in size. Patient received adequate therapy for acute kidney injury (most probably clindamycin-induced). I.v. treatment with ceftazidime according to antibiogram and thiamazole was administered. The patient was qualified for incision and percutaneous drainage. She was discharged after 11 days of hospitalization presenting significant clinical improvement. A year later on US six mixed solid/cystic lesions of size below 1 cm were visualized, benign on FNAB. She remains clinically and biochemically euthyroid. Typical infections with Salmonella concern gastrointestinal tract, while conditions associated with atypical infections are: HIV infection, transplant recipients, diabetes mellitus, thyroid gland disorders (e.g. multinodular goiter, after FNAB), anatomical abnormalities (piriform sinus fistula), corticosteroid therapy, advanced age, neoplastic disease and contact with breeding animals. The only risk factor for acute thyroiditis in our patient was diabetes mellitus, although it was well-controlled.