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ORIGINAL ARTICLE
Year : 2014  |  Volume : 3  |  Issue : 3  |  Page : 180-183

Acute suppurative thyroiditis in pre-existing goiter in diabetic patients


1 Fellow Neurosurgery, Park Clinic, Kolkata, West Bengal, India
2 Department of Physiology, S.C.B Medical College, Cuttack, Odisha, India
3 Department of General Surgery, S.C.B Medical College, Cuttack, Odisha, India

Correspondence Address:
Biswaranjan Nayak
Park Clinic, 4-Gorkey Terrace, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.138602

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Background: Thyroid abscess is a rare clinical entity and infrequently encountered. We hereby present a review of 11 adult age group patients who presented to our hospital, which is a tertiary care referral center with thyroid abscess and the management being incision and drainage of abscess. Aims and Objective: In this paper, we have studied the association of acute suppurative thyroiditis (AST) with diabetes mellitus (DM), its early diagnosis and management. Materials and Methods: All the suspected AST cases were admitted to endocrine surgical unit of S.C.B Medical College and Hospital, Cuttack, India and studied prospectively. Thorough history taking and physical examination were done. All blood counts, serology and thyroid function were done. Plain radiograph, ultrasonography, computed tomography scan, magnetic resonance imaging of the neck were done as per the requirement. Indirect laryngoscopy was done as a routine procedure. Diagnostic aspiration was done in every case followed by incision and drainage. Results: We report our observations from the 11 cases of AST being managed in endocrine surgical unit. All the patients were of female sex and their age ranging from 27 to 65 years. Each of them had a pre-existing goiter of duration from 1 to 7 years. Staphylococcus aureus (nine cases) was the most common pathogen followed by Escherichia coli (two cases). Proper antibiotics as per culture sensitivity (cefuroxime, amikacin), control of diabetes with insulin, daily copious irrigation of the wound with normal saline healed all these abscesses. They were discharged from the hospital after full resolution of the infection and underwent thyroidectomy at a later date. Conclusion: Type-2 DM is rapidly emerging as a public health problem in South East Asia particularly in India leading to a wide variety of infectious complications in different anatomic locations. It is the single most important cause of AST in our population. Early recognition and prompt institution of surgical and endocrinological management by a multidisciplinary team is required and hence diabetic patients with pre-existing goiter should be recommended for planned thyroidectomy at an early date to reduce its complication. S. aureus is the most common pathogen followed by E. coli in our study group.


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