Idiopathic thyroid abscess in a healthy 22-year old female – A case of anchoring bias

Abstract Thyroid abscess is a rare pathology, accounting for less than 1% of all thyroid diseases. Those who do experience thyroid abscesses are commonly immunocompromised, as the thyroid is highly resilient to infections. Here, we illustrate a case of a thyroid abscess in a young, healthy patient with no pre-existing medical conditions or anatomical abnormalities. Initial emergency department CT imaging illustrated a cystic, homogenous neck mass that was initially suspected to be a thyroid carcinoma. The patient was referred to the Department of Endocrine Surgery at a tertiary academic medical center for workup and management. On presentation to Endocrine Surgery, the patient complained of fever, progressive swelling of the mass causing an inability to move her neck, inability to eat or drink, inability to lie flat due to shortness of breath, and new-onset sialorrhea and voice changes. Bedside ultrasound and fine-needle aspiration confirmed a thyroid abscess, and the patient was emergently taken to the operating room for neck exploration, hemithyroidectomy, and incision/drainage of the thyroid abscess.