Acute Suppurative Thyroiditis as a Rare Complication of Aggressive Chemotherapy in Children With Acute Myelogeneous Leukemia

Abstract

Acute suppurative thyroiditis (AST) is quite rare, even in immunocompromised patients. The authors describe 2 cases of AST during aggressive chemotherapy for acute myelogeneous leukemia (AML). They were treated with aggressive combination chemotherapy and achieved complete remission. After several courses of chemotherapy, they developed fever and pain in the region of the thyroid gland. Laboratory tests showed hyperthyroidism and elevated levels of thyroglobulin and C-reactive protein. Ultrasonography revealed hypoechoic areas in the thyroid gland. A diagnosis of AST was made. Bacterial infections were suspected because they were sucessfully treated with antibiotics. After a month, the patients' thyroid function and thyroglobulin levels returned to normal without a period of transient hypothyroidism. A pyriform sinus fistula was not demonstrated. The results suggest that neutropenia and preceding cellulitis around the thyroid gland, which might be subsequent to oral mucosal damage induced by anticancer drugs, may play a role in the development of AST. AST should be considered a potential complication of aggressive chemotheragy for leukemia.

Thyroid abscess in case of Pre B acute lymphoblastic leukaemia: a rare presentation

“…Acute suppurative thyroiditis is a rare condition even in patients with impaired host defences 2. To the best of our knowledge, there are only two case reports of thyroid abscess in patients of ALL.…”

Thyrotoxicosis as a rare presentation in acute suppurative thyroiditis: a case report

“…The majority of individuals with acute suppurative thyroiditis fall into one of four categories: (1) thyroiditis caused by bacterial infection through a pyriform sinus fistula, (2) infection of a thyroid nodule or cancer, (3) infection caused by esophageal rupture owing to foreign-body ingestion or esophageal malignancy, and (4) infection of the normal thyroid gland [ 7 , 16 ]. Hematogenous spread, direct invasion of neighboring tissues, lymphatic spread, direct trauma, and persistent thyroglossal duct are all possible routes of infection [ 8 ]. Up to 95% of AST develops in the left thyroid lobe.…”

Thyrotoxicosis Due to Acute Suppurative Thyroiditis in a Pediatric Patient: A Case Report

“… 13 , 14 , 24 , 26 - 31 To our knowledge, there have only been 5 reported cases in pediatric patients. 12 , 17 , 32 The mechanism is thought to be due to the release of preformed thyroid hormone from the destruction of thyroid follicles. 1 , 13 , 17 , 26 In these instances, patients can present with a variety of hyperthyroid symptoms, including anxiety, anorexia, palpitations, diaphoresis, tremors, weight loss, diarrhea, insomnia, and irritability.…”