Thyroid abscess as a primary presentation of tuberculosis: a case report.

INTRODUCTION: Thyroid tuberculosis (TB) is infrequently reported even in regions with high TB prevalence, due to the gland's inherent resistance and nonspecific clinical presentations. Involvement of the thyroid gland in extrapulmonary TB is an uncommon occurrence. It can manifest as various thyroid conditions, making timely diagnosis challenging and necessitating a high level of clinical suspicion. This report presents a case of thyroid cold abscess caused by TB. The goal is to raise awareness among clinicians about this possibility and to emphasize its clinical management.

CASE PRESENTATION: This study presents a case of a 14-year-old girl diagnosed with a tubercular thyroid abscess. Clinical examination, imaging, and fine-needle aspiration (FNA) cytology confirmed the diagnosis, revealing granulomatous inflammation consistent with TB. This case underscores the diagnostic challenges posed by thyroid TB due to its mimicry of malignancies and other thyroid pathologies. FNA biopsy and imaging are critical tools for diagnosis. Though antitubercular therapy (ATT) remains the primary treatment, surgical intervention is necessary in some cases. Awareness of this rare condition is essential for timely diagnosis and management, particularly in endemic regions.

DISCUSSION: Thyroid TB should be considered in patients presenting with non-tender, cold nodules, especially in high-risk populations, including those with comorbidities or from TB-endemic areas. A thorough history and examination are crucial to identifying atypical extrapulmonary manifestations. This discussion underscores the importance of clinical vigilance and a multidisciplinary approach to managing this rare and complex condition.

CONCLUSION: Tubercular thyroid abscess is an exceptionally rare clinical entity, often presenting diagnostic challenges due to its nonspecific symptoms and resemblance to other thyroid conditions such as malignancies or cystic lesions. This case highlights the importance of considering thyroid TB in the differential diagnosis of thyroid swellings, especially in endemic regions. Treatment with ATT remains the cornerstone of management, while surgical interventions may be required for abscess drainage or complications.