[Infectious thyroiditis as initial manifestation of embolizing endocarditis of the aortic valve].
METHODS
A 47-year-old patient was admitted to hospital with fever (39.2 degrees C), weight loss and sore throat. The right thyroid area was painful on palpation.


METHODS
The erythrocyte sedimentation rate was 56/86 mm, white blood cell count 10,600/l, with shift to the left and toxic granulations. Blood culture grew Streptococcus mitis; the echocardiogram showed vegetations on the aortic valve. Therefore aortic valve endocatidits was suspected. Ultrasound examination of the thyroid gland showed an echo poor area with an enlarged thyroid artery; thyroid cytodiagnosis was unremarkable.


METHODS
The fever quickly subsided on administration of penicillin G (7.5 mill I.U. three times daily) and tobramycin (80 mg three times daily) for two weeks, followed by penicillin G in the same dosage for four more weeks. Vancomycin was then given for two weeks (1 g twice daily intravenously). The aortic valve vegetations were no longer seen three weeks after onset of treatment. Two months after discharge the thyroid and heart were normal on ultrasound examination.


CONCLUSIONS
Bacterial thyroiditis was caused by embolisation to the thyroid artery from vegetations on the aortic valve in aortic valve endocarditis, probably due to carious teeth.
Hofbauer
L C
LC
Klinikum Innenstadt der Universität, München.
Spitzweg
C
C
Tammen
A R
AR
Heufelder
A E
AE
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001021:Aortic Valve; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000150:complications*; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D013961:Thyroid Gland / Q000098:blood supply*; D013966:Thyroiditis / Q000000981:diagnostic imaging / Q000209:etiology*; D013997:Time Factors; D014031:Tobramycin / Q000627:therapeutic use; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D010406:Penicillins; D014640:Vancomycin; D010400:Penicillin G; D014031:Tobramycin