Thyroid Pneumatosis Following Fishbone Ingestion: A Rare Case Report

Background: Thyroid pneumatosis is an extremely rare condition, previously reported only once as a complication of an ultrasound-guided thyroid fine needle aspiration (FNA). Case Report: A 70-year-old male sought emergency care after experiencing a foreign body sensation in his throat. He was diagnosed with a retropharyngeal abscess caused by upper digestive tract perforation from fishbone ingestion, which was surgically extracted. Postoperative day 3, a neck computed tomography (CT) revealed gas bubbles within the thyroid parenchyma, indicative of thyroid pneumatosis, likely leading to destructive thyroiditis (TSH 0.109 µUI/mL, free T4 of 27.1 pmol/L, and free T3 of 4.08 pmol/L). A multidisciplinary team opted for a conservative approach, and the patient showed a favorable recovery. Thyroid function normalized within 2 months (TSH 2.44 mUI/mL, free T4 13.6 pmol/L, and free T3 4.58 pmol/L). Conclusion: Thyroid pneumatosis should be recognized as a potential rare complication following esophageal perforation. This is the first documented case linking destructive thyroiditis to thyroid pneumatosis.