Managing Bartholin Gland Abscess and Thyroid Issues: Key Concerns

1. Bartholin's gland abscess 2. Hyperthyroidism 3. Drug allergy

1.
Bartholin's gland abscess: In June 2020, I was hospitalized due to fever and underwent a Bartholin's gland cyst excision surgery, with a good postoperative outcome.

2.
On April 1st of this year, I discovered thyroid function issues with Free T4 at 3.45 and TSH > 0.005, so I started medication: one tablet of Methimazole in the morning and evening, and one tablet of Propranolol in the morning and evening.

3.
During my hospitalization for the Bartholin's gland cyst excision, I was found to be allergic to cefazolin, a cephalosporin antibiotic.

Hello, doctor.
I have a few questions.
On the 15th of this month, I noticed that the Bartholin's gland abscess has recurred, causing swelling and pain.
Since my attending physician was unavailable, I went to a clinic where they advised me to take medication: Amoxicillin 500 mg and Clindamycin 500 mg, three times a day.
However, after five days, the swelling and pain worsened.
On the 20th, I consulted my attending physician, who drained the abscess, providing significant relief.
However, just one day later, the swelling returned, and I started experiencing pain again.
Is it possible that the antibiotics were ineffective? My attending physician prescribed Gastric mucosal protectants and Clonidine three times a day, and Lincosamide capsules every six hours, two capsules each time, along with Pseudomonas antibiotic twice a day, two capsules each time.

Question 1: Does taking antithyroid medication lower my immune system, leading to the recurrence of the Bartholin's gland abscess?
Question 2: I heard from my doctor that repeated infections of the Bartholin's gland could lead to the recommendation for complete gland excision, but isn't surgery unsuitable for patients with hyperthyroidism due to the risk of thyroid storm?
Question 3: Regarding Pseudomonas antibiotics, I read online that some individuals have suffered liver failure or developed Stevens-Johnson syndrome (SJS) after using them for acne treatment.
Is this type of antibiotic more likely to cause allergic reactions? Given my allergy to cephalosporin antibiotics, should I avoid Pseudomonas antibiotics to prevent allergic reactions?

Yao Yao, 30~39 year old female. Ask Date: 2021/04/21

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it is unrelated to taking antithyroid medications.
Due to recurrent relapses, surgery is still recommended, as the effect of just taking antibiotics is limited.
Wishing you good health.

Reply Date: 2021/04/21

More Info

Managing Bartholin Gland Abscess and Thyroid Issues: Key Concerns
It sounds like you are dealing with a complex medical situation involving a recurrent Bartholin gland abscess and thyroid issues. Let's address your concerns one by one, based on the information you've provided.

Question 1: Does taking antithyroid medication lower immunity, leading to the recurrence of the Bartholin gland abscess?
Antithyroid medications, such as methimazole or propylthiouracil, are primarily used to manage hyperthyroidism by inhibiting the production of thyroid hormones. While these medications can have side effects, including a potential decrease in white blood cell counts (agranulocytosis), they do not directly suppress the immune system in the same way that corticosteroids or immunosuppressive drugs do. However, if your white blood cell count is affected, it could theoretically make you more susceptible to infections. It’s essential to monitor your blood counts regularly while on these medications. If you notice recurrent infections, it would be wise to discuss this with your healthcare provider, who may consider adjusting your treatment or investigating further.

Question 2: Is it true that patients with hyperthyroidism are not suitable for surgery due to the risk of thyroid storm?
Thyroid storm is a rare but life-threatening condition that can occur in individuals with untreated or poorly managed hyperthyroidism, particularly during stress, surgery, or infection. While surgery can pose risks for hyperthyroid patients, it does not mean that surgery is entirely off the table. If surgery is necessary, such as for the removal of the Bartholin gland, it is crucial to ensure that your thyroid condition is well-managed before proceeding. This may involve stabilizing your thyroid levels with medication prior to any surgical intervention. Your healthcare team will weigh the risks and benefits of surgery in your specific case, and they may take precautions to minimize the risk of thyroid storm.

Question 3: Should I avoid taking Pseudomonas antibiotics like Piptazobactam due to my allergy to cephalosporins?
If you have a known allergy to cephalosporins, it is prudent to exercise caution with other antibiotics, especially those that may have cross-reactivity. Piptazobactam (Piperacillin/Tazobactam) is a penicillin-based antibiotic, and while it is not a cephalosporin, some individuals with penicillin allergies may also react to it. The risk of severe allergic reactions, such as Stevens-Johnson syndrome (SJS) or liver failure, is generally low but can occur. It is crucial to inform your healthcare provider about your allergy history so they can prescribe antibiotics that are safe for you. If you have concerns about a specific medication, discussing alternative options with your doctor is advisable.

Additional Considerations
1. Monitoring and Follow-Up: Given your history of recurrent Bartholin gland abscesses, regular follow-up with your healthcare provider is essential. If you experience worsening symptoms or new side effects from medications, seek medical advice promptly.

2. Infection Management: If antibiotics are not effectively managing your abscess, further evaluation may be necessary. This could include imaging studies or a referral to a specialist, such as a gynecologist or an infectious disease expert.

3. Lifestyle and Support: Maintaining a healthy lifestyle, including proper nutrition and stress management, can support your immune system. Additionally, consider discussing any concerns about your medications with a pharmacist or a healthcare provider who can provide personalized advice.

In conclusion, managing your health conditions requires a coordinated approach involving your primary care physician, endocrinologist, and possibly a surgeon. Open communication about your symptoms, medication side effects, and any allergies will help ensure you receive the best care possible.

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