Category: Thyroid

Monitor: 2

2 - COCCIDIODIDES THYROIDITIS - A RARE CAUSE OF A COMMON ENDOCRINE DISORDER

Thursday, Apr 25
11:00 AM – 11:30 AM

Objective : Thyroiditis is a common complaint in every endocrine practice and we typically think it is caused by a viral illness or other stressfull event. Here we present a case of an extremely rare cause for thyroiditis, coccidoides, which more commonly presents as a fungal pneumonia.

The patient was a 69 male who presented due to abnormal function tests after a recent ER visit for fever. He had testing showing Valley Fever (coccidoides pneumonia) and saw his infectious disease doctor, who sent labs, revealing a suppressed TSH (< 0.01) and elevated free T4 (3.0, nl (0.8-1.5ng/dl). At the time, he had no sx of tachycardia, plapitations, weight loss or other symptoms of hyperthyroidism. He had an uptake scan one month later, showing normal uptake at 11% with complete nonvisualiztion of the left lobe.  In clinic, we did a bedside ultrasound, showing a large thyroid nodule on the left.  One month after initial testing, thyroid function tests had normalized, so biopsy was done, revealing mycotic elements. He was sent for thyroidectomy, which showed evidence of coccidioides infection.


Methods : n/a


Results : n/a


Discussion :

There are only 3 reported cases of coccioides related thyroiditis in the literature thus far. The first case was in 1979. Since then, only two other cases have been presented. One of the cases was in an immunocompromised host with HIV infection, thus this is exceedingly rare in immunocompetent adults.

In this case, the patient needed total thyroidectomy as part of his treatment for disseminated coccidioides. Treatment with fluconazole alone would not have been enough to treat his infection.


Conclusion : Although coccidioides is rare, it can cause thyroiditis and/or thyroid nodules. In a patient with a diseminated infection, it is important to keep infectious etiologies on the differential, as they do change management.

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Rebecca L. Weiss

Associate Physician
Kaiser Permanente, SCPMG

Rebecca Weiss is an endocrinologist practicing in southern California. She completed her residency in medicine at UCLA in 2015. She stayed on at UCLA to finish her fellowship in Endocrinology, focusing on thyroid diseases and transgender care. Dr. Weiss completed fellowship in 2017. She has since been practicing clinical endocrinology at Kaiser Permanente Woodland Hills Medical Center.

Rebecca L. Weiss

Associate Physician
Kaiser Permanente, SCPMG

Rebecca Weiss is an endocrinologist practicing in southern California. She completed her residency in medicine at UCLA in 2015. She stayed on at UCLA to finish her fellowship in Endocrinology, focusing on thyroid diseases and transgender care. Dr. Weiss completed fellowship in 2017. She has since been practicing clinical endocrinology at Kaiser Permanente Woodland Hills Medical Center.