Giant Thyroid Gland Abscess Causing Upper Airway Obstruction: A Case Report

Figures & data

Figure 1 Anterior (A) and lateral (B) neck view of the patient with thyroid gland abscess.

Figure 2 Rigid bronchoscopy of the patient showing nearly closed glottis before intubation.

Table 1 Laboratory Results of the Patient Upon Initial Presentation and at Discharge

Complete Blood Count	Presentation	Discharge	Reference range
White blood cell	25.47 x 10^3	11.1 x 10^3	3.9–10.1×10^3 /mm^3
Neutrophil	94.7%	79.9%	30.4–74.6%
Lymphocyte	3.4%	15.5%	17.8–61.5%
Hemoglobin	9.1	9.2	10.4–14.7 g/dl
Hematocrit	26.3	27.6	34.4–48.3%
Mean cell volume	79.9	81.6	74.3–98.3 fl
Mean cell hemoglobin	27.5	27.1	25.7–33.6 pg
Platelet count	685 x 10^3	345 x 10^3	100–300×10^3 /µL
C-reactive protein	89	–	0–10 mg/dl
Erythrocyte sedimentation rate	42	–	0–20 mm/hr
PICT for HIV	Non–reactive
Prothrombin time	15.2	–	13–16.1/sec
Activated partial thromboplastin time	30.8	–	36.3–44.8/sec
International normalized ratio	1.34	–	1–1.35
Creatinine	0.5	0.6	0.5–0.9 mg/dl
Urea	10	12	10–50 mg/dl
Aspartate amino-transferase (AST)	12	14	< 37 U/L
Alanine amino-transferase (ALT)	13	16	< 42 U/L
Alkaline phosphatase (ALP)	204	193	64–306 U/L
Sodium	143	138	136–145 mmol/l
Potassium	2.81	3.65	3.5–5.5 mmol/l
Calcium (ionized)	1.23	1.25	1.05–1.35 mmol/l
Magnesium	1.4	2.01	1.9–2.5 mg/dl
Thyroid-stimulating hormone (TSH)	0.456	–	0.274–4.256 µIU/mL
Free triiodothyronine (FT3)	3.644	–	3.058–6.764 pmol/l
Free tetraiodotyronine (FT4)	20.88	–	10.53–21.16 pmol/l
Thyroid fluid analysis
Cell count	108,000/mm^3
Neutrophil	85%
Lymphocyte	15%
Protein	6.3 g/dl
Glucose	45 mg/dl
Random blood sugar	150 mg/dl

Abbreviations: PICT, Provider Initiated Counseling and Testing; HIV, Human Immunodeficiency Virus.

Figure 3 Bedside neck ultrasound of the patient showing hypoechoic lesion in the right lobe of the thyroid gland as depicted by the arrow.

Figure 4 Head and neck post-contrast CT scan of the patient. (A) axial view of a huge thyroid abscess more on the right side as depicted by the red arrow; (B) coronal view of the same lesion causing lateral compression of the trachea and esophagus; (C) sagittal view of the same lesion.

Figure 5 (A) Needle aspiration of thyroid abscess; (B) after draining 450 mL of pus; (C) drained pus.