Acute bacterial thyroiditis secondary to urosepsis.

Case Report An 85-year-old male visitor from out of state was brought to the emergency department with complaints of weakness, fever, and malaise for approximately 1 week. His history was notable for a large goiter, which had been present for at least 10 years and caused only mild dysphonia. The goiter had apparently never been treated. The patient initially denied dyspnea and dysphagia. On admission his temperature was 101°F; he had a large, firm nontender goiter and a markedly enlarged prostate. A urinalysis showed many bacteria and 5 to 20 white cells per high power field. His blood urea nitrogen (BUN) was 67 mgt dL, creatinine 2.8 mg/dL, and blood glucose 228 mg/dL (he had no known history of diabetes). There was a marked leukocytosis (white blood count 28.1 X 103/J.lL) and a mild normochromic anemia (hemoglobin 10.9 g/dL) on a complete blood count. Thyroid function studies showed a free thyroxine level of 2.4 ng/dL (normal 0.7 to 2.2 ng/dL) and a thyroid-stimulating hormone level of 0.1 J.lU/mL (normal 0.5 to 4.0 J.lU/mL). Because we suspected urosepsis, the patient was admitted to the intensive care unit and prescribed intravenous cefotaxime, 1 g every 8 hours. He initially showed clinical improvement; however, 2 days after admission, his voice became quite hoarse, and he began to develop dysphagia and dyspnea. On physical examination, the goiter appeared unchanged from admission, but a lateral radiograph of his neck showed