Thyrotoxicosis Due To Acute Suppurative Thyroiditis In A Postpartum Woman

Abstract

Objective: Postpartum thyroiditis is usually painless, is typically accompanied by thyrotoxicosis, and has an autoimmune pathogenesis. Here we present a case of acute suppurative thyroiditis with thyrotoxicosis in a postpartum woman. Methods: The following is a case report with a review of the literature. Results: A 24-year-old female, 5 months postpartum, presented with neck pain, palpitations, and fevers for 2 weeks. One month prior to presentation, she was treated with amoxicillin and prednisone for strep throat, with persistent symptoms. Blood pressure was 141/86 mm Hg and heart rate was 135 beats per minute. Examination revealed thyromegaly with a palpable, tender left thyroid nodule. Labs revealed low thyroid stimulating hormone (0.13 μIU/mL), elevated free thyroxine (2.04 ng/dL), and leukocytosis. Thyroid antibodies were normal. Thyroid ultrasound revealed a 3.4-cm complex nodule found to be hypofunctioning on a technetium pertechnetate scan. Computerized tomography of her neck showed an exophytic mass in the left lobe and an adjacent 1.1-cm abscess. She underwent fine needle aspiration of both lesions; each site grew Streptococcus constellatus. She was treated with vancomycin and piperacillin-tazobactam while inpatient and was discharged on Augmentin. At a 5-week follow-up, her thyroid function tests had normalized. Conclusion: Acute suppurative thyroiditis is a rare entity, with only two cases reported in the postpartum setting. It is known to be more common in immunocompromised individuals, though it is unclear if postpartum status is also a risk factor. Abscess formation is common, which can be due to direct or hematogenous spread. It must be recognized and treated quickly. Abbreviations: CT = computerized tomography; FNA = fine needle aspiration; 99mTc = technetium