Postpartum Thyrotoxicosis Coexisting with Acute Suppurative Thyroiditis Caused by Peptostreptococcus

ABSTRACT

Acute suppurative thyroiditis (ST), which is usually caused by bacterial infection of the thyroid gland is a rare, but potentially life-threatening condition. The organisms most often isolated from acute ST patients are aerobic bacteria. Herein, we present a rare case of ST with thyroid abscess and thyrotoxicosis in the postpartum period caused by Peptostreptococcus. A 24-year-old female presented to our clinic on postpartum day 5 with severe neck pain when swallowing, chills and fever. Physical examination showed fever (38 °C), tachycardia, and an erythematous non-fluctuant mass over the left lobe of the thyroid. The results were compatible with hyperthyroidism due to thyroid tissue destruction. Ultrasonography (USG) of the thyroid showed a 10.1x14.5x25.6 mm heterogeneous hypoechoic lesion in the left lobe. Thyroid aspirate cultures showed Peptostreptococcus growth and because the sensitivity of it antibiotherapy was not changed. Two weeks later, thyroid USG showed that the abscess shrank to 2.2x3.1x4.2 mm. On the 20th day of antimicrobial therapy, all clinical and laboratory signs and symptoms of the infection were resolved. In the presented case, a rarely seen anaerobe Peptostreptococcus was isolated from the patient’s thyroid abscess and she was treated with parenteral ampicillin/sulbactam therapy and multiple thyroid abscess aspirations. Thyrotoxicosis was resolved with no medications. During the follow-up period, the patient’s prognosis was excellent and she had no complaints.