A Case of Acute Suppurative Thyroiditis Accompanied by Transient Abducens Nerve Palsy

ABSTRACT Objective: This article reports the case of a 66-year-old female that developed right abducens nerve palsy 1 week after the onset of acute suppurative thyroiditis on her left side. Recurrent laryngeal nerve palsy has not been previously reported in a patient with acute suppurative thyroiditis and abducens nerve palsy. Methods: A medical examination of the patient revealed abnormal eye movements but no other abnormal neurological findings. Warmth, redness, and tenderness in the left anterior neck were noted along with right abducens nerve palsy. Laboratory data suggested a bacterial infection. Serum thyroid hormone and thyroglobulin concentrations were elevated. Computed tomography demonstrated unclear edematous changes together with the presence of air noted on the left side of the upper thyroid. Results: The patient was treated with an empiric broad-spectrum antibiotic and her suppurative thyroiditis improved. Two months after therapy, the right abducens nerve palsy improved without additional treatment. Computed tomography of the neck performed after oral administration of a contrast agent revealed contrast accumulation in a pyriform sinus fistula located in the left inferior angle of the thyroid cartilage. Conclusion: To minimize the potential for developing serious complications, it is critical that acute suppurative thyroiditis be diagnosed rapidly, the causative organism accurately identified, and the appropriate measures be taken promptly. With this patient, we postulate that the inflammation located on the left side of the upper thyroid may have caused a compensatory increase in venous flow or intracranial pressure, resulting in right abducens nerve palsy.