Tuberculous abscess of the thyroid gland with compressive symptoms: a case report

Abstract

Introduction: Thyroid involvement by Mycobacterium tuberculosis is uncommon and may mimic neoplasia or subacute thyroiditis. Diagnostic delay is frequent because cytology from the thyroid gland can be non-diagnostic, and clinical features overlap with other inflammatory and malignant conditions.

Case report: A 70-year-old woman with pulmonary tuberculosis presented with several weeks of progressive right-sided neck swelling, dyspnoea and odynophagia, accompanied by night sweats and weight loss (~10 kg over three months). Examination revealed a 5-cm right neck mass (level II) and a palpable supraclavicular node; thyroid function was normal. Ultrasonography demonstrated a 5-cm thyroid lesion. Fine-needle aspiration of the thyroid was non-diagnostic, whereas aspiration of a supraclavicular node confirmed tuberculosis. Owing to compressive symptoms and suspected suppuration, surgical drainage with total thyroidectomy was undertaken; specimens were submitted for histopathology.

Discussion: Thyroid tuberculosis, though rare, should be considered in endemic settings and in patients with systemic risk factors. Image-guided sampling of cervical lymph nodes can increase diagnostic yield when thyroid cytology is equivocal. Management is primarily medical with standard anti-tuberculous therapy; surgery is reserved for large abscesses, airway compromise, failure of percutaneous control or diagnostic uncertainty. This case illustrates the value of targeted sampling, timely source control and multidisciplinary care.