No signs of metastasis were apparent, including in the lungs and bone. The thyroid mass resulted in displacement of the trachea toward the left and showed enhancement in the peripheral area of the nodule (Fig. Contrast-enhanced computed tomography (CT) confirmed a 37вЂ‰Г—вЂ‰37вЂ‰Г—вЂ‰42-mm nodule within the right thyroid lobe at the middle and lower pole. Neck ultrasonography showed a 47-mm nodule, with ill-defined margins, irregular form, and a hypoechoic, heterogeneous appearance, in the area of the right thyroid, suggesting thyroid malignancy (Fig. Negative results were obtained for thyroglobulin antibody and serum thyroglobulin level was high (3590В ng/mL). A slight increase in thyroid-stimulating hormone (TSH) was also identified, showing subclinical hypothyroidism. Hematological tests revealed a high erythrocyte sedimentation rate (102В mm/hr) and elevated concentrations of C-reactive protein (10.4В mg/dL). Table 1 shows the results of laboratory examination at the first visit (day X). Axillary temperature was 36.9вЊ, heart rate was 109 beats/min, and blood pressure was 169/88В mmHg. The patient had no medical history of note, and no infectious symptoms such as cough, headache, or abdominal or joint pain were identified, other than the neck pain. The nodule showed limited mobility and no adjacent lymphadenopathy. On examination, a nodule showing pain, erythematous changes, and warmth was palpable in the anterior neck on the right side. She had no chronic diseases and appeared not to be to be in an immunocompromised state (she was well-nourished, had no diabetes and did not use any steroids, and human immunodeficiency virus (HIV) antibody was negative). We have to take it into our account that malignant tumor may exist in the background when AST is identified on the right side of thyroid gland with a healthy subject.ДЄ 59-year-old woman was introduced to our hospital with a 4-week history of fever, sore throat, and swollen neck, after first visiting a primary-care physician and receiving antibiotics. The reason why AST coincided with malignant thyroid tumor is unclear. This report represents a rare case of AST associated with PTC on the right side of thyroid gland, found in a healthy adult woman.

Histological findings revealed a 20-mm PTC in the right lobe with sternothyroid muscle invasion of the tumor. The patient subsequently underwent total thyroidectomy and bilateral level D1 lymph node dissection.

So, FNA was repeated again and cytological examination confirmed papillary thyroid carcinoma (PTC). Four months later, neck ultrasonography showed a significant decrease in size of the nodule in the right thyroid gland to 27В mm, but the lesion still resembled a malignant nodule. Image findings such as CT scan did not show any piriform sinus fistula. Complete response was obtained by an intravenous administration of antimicrobial agents within a week. Based on the clinical course and cytology, AST was confirmed to be diagnosed. Fine needle aspiration (FNA) biopsy specimen revealed numerous number of neutrophils in the background without nuclear atypia. Neck ultrasonography showed a 47-mm, hypoechoic, heterogeneous nodule with ill-defined margins and irregular form, suggesting a right thyroid malignant nodule. The patient appeared not to be immunodeficient. Case presentationДЄ 59-year-old woman was introduced to our hospital for the further examination with fever, sore throat, and right anterior neck swelling. Herein, we report a rare case of AST in the right thyroid lobe of adult woman without any immunocompromised condition. AST is also usually seen in immunocompromised hosts. AST typically takes places on the left side the neck region in children, because of the coincidence of the left piriform sinus fistula, as a most common route of infection. Therefore, acute suppurative thyroiditis (AST), as a bacterial infection of the thyroid gland, is rarely seen. The thyroid gland is resistant to microbial infection, because of its organ characteristics such as encapsulation, iodine content, and rich blood supply.

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