ESPE2023 Poster Category 1 Thyroid (44 abstracts)
Hyperthyroidism caused by severe bacterial infection
Monika Flury 1 , Gemulla Gita 1 , Susen Reichardt 1 , Kristina Stamos 2 , Heike Taut 3 , Gabriele Hahn 4 & Angela Huebner 5
1Division of Paediatric Endocrinology and Diabetes, Children's Hospital, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. 2Division of Paediatric Pneumology and Allergology, Children's Hospital, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. 3Division of Paediatrics, Children's Hospital, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. 4Department of Radiology, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. 5Universitätsklinikum Carl Gustav Carus, Dresden, Germany
We report on a nearly 4-year-old girl who presented to the emergency room of our paediatric clinic with high fever and poor general condition, swelling of the neck and swallowing difficulties. Laboratory chemistry showed a marked hyperthyroid metabolic state, so that initially a thyrotoxic crisis in Graves' disease was considered (TSH 0.03 mU/L (-), fT4 28.10 pmol/l (+)). Therefore, a short-term therapy with thiamazole was given. The thyroid autoantibodies were negative. The inflammation values were high (CRP 134.6 md/L, leucocytes 22.53 GPt/l). Clinically, there was a slight reddening of the pharyngeal ring, the tonsils were inconspicuous. Sonography revealed a marked, abscessed, purulent inflammation of the thyroid gland, especially of the left lobe. MRI of the neck revealed an extensive retropharyngeal abscess on the left with extension into the thyroid lobe (left > right) with significant inflammatory surrounding reaction cervically into the upper mediastinum and periclavicular. Strepotoccus anginosus was detected in the blood culture. Intravenous antibiotic therapy with ampicillin and sulbactam was administered for 3 weeks and oral therapy with amoxiclavulanic acid for another 4 weeks. There was a restitutio ad integrum. An immunodeficiency could not be found.
Conclusion: An untreated retropharyngeal abscess in our patient led to severe purulent thyroiditis with hyperthyroidism and sepsis. Antibiotic and supportive therapy led to complete recovery after 7 weeks.
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