Acute Suppurative Thyroiditis in Post Arteriovenous Shunt Infection Patient

Keywords: acute suppurative thyroiditis, hyperthyroid, chronic kidney disease, arteriovenous shunt, hemodialysis

Abstract

Acute suppurative thyroiditis (AST) is a rare clinical entity that must be treated immediately because of its morbidity, especially swelling in the thyroid area accompanied by fever. AST is often preceded by infection at another site; therefore, it is important to identify the source. A 40-year-old woman came to the Dr. Soetomo General Hospital complaining of pain and swelling in the neck, difficulty swallowing, and fever. The patient suffered from chronic kidney disease. One week before, she had an infected arteriovenous hemodialysis shunt. Laboratory results showed an increased fT4 (3.5 ug/dL) and a decreased TSH (0.015 uIU/mL), leukocytosis, and a raised C reactive protein (CRP). Thyroid ultrasound showed an abscess involving the entire left thyroid. Thyroid fine needle biopsy showed AST. Culture of the pus grew Staphylococcus aureus. The thyroid tests supported the diagnosis of AST with hyperthyroidism; immediate treatment was indicated. Three weeks after treatment, the patient was euthyroid and still had drainage of the wound. The AST was considered to be secondary to the hemodialysis AV shunt infection. Leukocytosis and increased CRP levels supported the presence of inflammation and culture grew Staphylococcus aureus. The patient improved with Clindamycin therapy. To our knowledge, this is the first AST case preceded by hemodialysis AV shunt infection.

Author Biographies

Ferdy Royland Marpaung, Rumah Sakit Dokter Soetomo

Department of Clinical Pathology, Faculty of Medicine, Univeritas Airlangga Dr.Soetomo Hospital, Surabaya, Indonesia

Aryati

Department of Clinical Pathology, Faculty of Medicine, Univeritas Airlangga Dr. Soetomo Hospital, Surabaya, Indonesia

Sidarti Soehita

Department of Clinical Pathology, Faculty of Medicine, Univeritas Airlangga Dr.Soetomo Hospital, Surabaya, Indonesia

References

Brent G, Larsen P, Davis T. Williams textbook of endocrinology. 13th ed. Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, editors. Canada: Elsevier; 2016. 442-5 p

Paes JE, Burman KD, Cohen J, Franklyn J, McHenry CR, Shoham S, et al. Acute bacterial suppurative thyroiditis: a clinical review and expert opinion. Thyroid. 2010 Mar;20(3):247-55. http://doi.org/10.1089/thy.2008.0146

Lamani YP, Basarkod SI, Telkar SR, Goudar B V, Ambi U. Thyroid abscess in immuno compromised patient: a case report. J Clin Diagn Res. 2012;6(1):106–7.

Hazard JB. Thyroiditis: a review. Am J Clin Pathol. 1955;25(3). https://doi.org/10.1093/ajcp/25.3.289

Coret A, Heyman Z, Bendet E, Amitai M, Itzchak I, Kronberg J. Thyroid abscess resulting from transesophageal migration of a fish bone: ultrasound appearance. J Clin Ultrasound: 1993;21(2):152-4. https://doi.org/10.1002/jcu.1870210215

Pearce EN, Farwell AP, Braverman LE. Thyroiditis. New Engl J Med. 2003;348(26):2646-55.

Oluwayemi IO, Abduraheem FO, Agaja OT, Oke OJ, Ogundare EO, Ajite AB, et al. Acute suppurative thyroiditis: a case report. Curr Pediatr Res. 2016;20(1-2):88–91.

Akuzawa N, Yokota T, Suzuki T, Kurabayashi M. Acute suppurative thyroiditis caused by Streptococcus agalactiae infection: a case report. Clin Case Reports. 2017;5(8):1238-42. https://doi.org/10.1002/ccr3.1048

de Mul N, Damstra J, van Dijkum N, Fischli S, Kalkman CJ, Schellekens WM, et al. Risk of perioperative thyroid storm in hyperthyroid patients: a systematic review Brit J Anaes. 127(6):879-89. https://doi.org/10.1016/j.bja.2021.06.043

Cantürk Z. (2019) Acute Suppurative Thyroiditis [Internet]. In: Özülker T, Adaş M, Günay S, editors. Thyroid and parathyroid diseases. Springer. 2019. https://doi.org/10.1007/978-3-319-78476-2_5

Sharma B, Bhavi V, Nehra H, Kumar A, Saran S, Mathur S. Thyroid abscess: a rare case report and review of literature. Thyroid Res Pract. 2018;15(1):49. http://doi.org/10.4103/trp.trp_47_17

Kurts C, Panzer U, Anders HJ, Rees AJ. The immune system and kidney disease: basic concepts and clinical implications. Nat Rev Immunol. 2013;13(10):738-53. https://doi.org/10.1038/nri3523

Carrero JJ, Stenvinkel P. Inflammation in end-stage renal disease—what have we learned in 10 years? Semin Dialysis. 2010;23(5):498-509. https://doi.org/10.1111/j.1525-139X.2010.00784.x

Lech M, Rommele C, Anders HJ. Pentraxins in nephrology: C-reactive protein, serum amyloid P and pentraxin-3. Nephrol Dial Transpl. 2013;28(4):803-11. https://doi.org/10.1093/ndt/gfs448

Cohen G, Hörl WH. Immune dysfunction in uremia—an update. Toxins. 2012;4(11):962-90. https://doi.org/10.3390/toxins4110962

Published
2022-06-20
How to Cite
Marpaung, F. R., Aryati, & Soehita, S. (2022). Acute Suppurative Thyroiditis in Post Arteriovenous Shunt Infection Patient. Christian Journal for Global Health, 9(1), 105-110. https://doi.org/10.15566/cjgh.v9i1.583