Suppurative thyroiditis: Systematic review and clinical guidance.

OBJECTIVE: Acute suppurative thyroiditis (AST) is a rare but potentially fatal condition which can initially be difficult to distinguish from the more common subacute thyroiditis (SAT). We aim to update understanding of this medical emergency. DESIGN: A systematic review over the past 20 years was performed on the epidemiology, clinical features, investigations, management and outcomes of AST. All full-text cases of microscopy or culture- proven AST in the English literature were included. RESULTS: 200 cases of AST have been described in 148 articles from January 2000 - January 2020. Bacterial AST is most common, often presenting with neck pain (89%) and fever (82%). Immunosuppression and pyriform sinus fistula are the most common causes, most often due to gram-positive aerobes. Transient hyperthyroidism is common (42%). Aspiration and antibiotics are becoming a more common treatment. Overall mortality was 7.8%. Tuberculous and fungal AST are less likely to present with fever and neck pain. Fungal AST is more common in immunosuppressed individuals (31%) and has a high overall mortality (33%). Tuberculous AST is more common in TB endemic areas. CONCLUSION: The symptoms and signs of AST commonly overlap with SAT and initially can be hard to diagnose. AST can be rapidly morbid or even fatal. Clinicians need to consider AST when they assess patients with thyroiditis who are systemically unwell, have high fever, high white cell count and c-reactive protein, tender neck and abnormal neck imaging. An investigative and treatment strategy is described based on a systematic review of the literature.

Acute suppurative thyroiditis with thyroid abscess in adults: clinical presentation, treatment and outcomes.

BACKGROUND: Abscess in the thyroid gland is a rare but severe infectious disease. The condition can have anatomic or iatrogenic underlying causes. If untreated it could be fatal. Pathogens vary considerably. Treatment is intravenous antibiotics, drainage, and sometimes surgery. METHODS: The electronic medical records of all adult patients with acute thyroiditis 2003-2017 treated at the Karolinska University Hospital (catchment area 2 million) in Sweden were systematically reviewed. RESULTS: Five patients were found in the catchment area. One patient from another region but known to us was also included. Thus, six patients (aged 28-73 years) were included in the study. Median length of hospital stay was 7.5 days (4-79 days). All were treated with antibiotics (intravenous n = 5, oral n = 1). Total antibiotic treatment duration was 13.5 days (10-41 days). Blood cultures were positive in three (streptococcus pneumonia, streptococci sanguineous, pepto streptococci), deep tissue culture in three (Escherichia coli, Candida, Hemophilic influenza) and no positive culture at all in two. Drainage was used in three patients. All patients recovered without recurrences. Surgery was performed twice in the acute phase in one. There was no recurrence during 7 years (3-12) of follow-up, but one patient died after three years (severe heart failure and pneumonia). CONCLUSION: Thyroid abscess in adults is extremely rare nowadays in the developed world. With prompt antibiotic therapy, drainage and in some cases thyroidectomy the prognosis seems favourable.

[Non-autoimmune thyroiditis]. / Tiroiditis no-autoinmunes.

The term thyroiditis comprises a group of thyroid diseases characterized by the presence of inflammation, including autoimmune and non-autoimmune entities. It may manifest as an acute illness with severe thyroid pain (subacute thyroiditis and infectious thyroiditis), and conditions in which the inflammation is not clinically evident evolving without pain and presenting primarily thyroid dysfunction and/or goiter (drug-induced thyroiditis and Riedel thyroiditis). The aim of this review is to provide an updated approach on non-autoimmune thyroiditis and its clinical, diagnostic and therapeutic aspects.

Acute Suppurative Thyroiditis in Children: Clinical Decision-Making.

Acute suppurative thyroiditis are infrequent infections, although their early and proper management are needed to reduce complications and recurrences. We review the clinical presentation, etiology, clinical outcome and management of 9 cases of thyroid infections diagnosed in children, and analyze the existence of predisposing factors for these infections.

Thyrotoxicosis as a rare presentation in acute suppurative thyroiditis: a case report.

BACKGROUND: Acute suppurative thyroiditis is a rare and potentially life-threatening disease. A few cases of acute suppurative thyroiditis associated with thyrotoxicosis have been reported in adults. We report a case of acute suppurative thyroiditis that was associated with thyrotoxicosis. CASE PRESENTATION: We report the case of a 49-year-old Iranian female presented with a painful neck swelling for a week. Computed tomography showed a well-defined gas-filled collection in the left thyroid lobe with an enhancing margin. The patient underwent two-phase surgery, first left thyroid abscess drainage and then total thyroidectomy. The result of histopathology examination was multinodular goiter with abscess formation without malignancy. CONCLUSION: Abscess formation and thyrotoxicosis is a very rare condition that occurs at the same time in acute suppurative thyroiditis. Despite antibiotic therapy being the first line of treatment, surgery is also required when antibiotic therapy fails.

Aspiration with or without lavage in the treatment of acute suppurative thyroiditis secondary to pyriform sinus fistula.

Objective There is currently no consensus regarding the optimal management of acute suppurative thyroiditis (AST) secondary to pyriform sinus fistula (PSF). To investigate the benefits and adverse events of aspiration with or without lavage for the treatment of AST secondary to PSF. Subjects and methods This was a retrospective analysis of consecutive patients with AST secondary to PSF who were admitted at the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University between August 2012 and December 2018. Clinical information, procedural data, and imaging data were analyzed. Results Seven patients (five women; mean age, 16.9 ± 6.3 years; range, 8-26 years) were included. The patients most presented with anterior neck pain and swelling (n = 7), fever (n = 7), or odynophagia (n = 5). Six cases of AST occurred on the left side of the thyroid and 1 on the right. All patients had thyroid abscess. AST was diagnosed by ultrasound-guided needle aspiration cytology in all cases. PSF was diagnosed during the inflammatory stage in five patients and during the quiescent stage in two. All patients were treated with empiric antibiotics. Needle aspiration without lavage was performed in three cases. Needle aspiration with lavage was performed in four cases. Repeat aspiration was performed in three cases. All patients recovered completely, with no procedure-related complications. During 18.3 ± 7.8 months of follow-up, AST recurred in one case. Excision of the PSF was performed in another case. Conclusion Ultrasound-guided aspiration with or without lavage had a good treatment effect and without adverse events for the management of AST secondary to PSF.

Management of pediatric head and neck infections in the emergency department.

Head and neck infections can spread to nearby structures, compromising the airway and progressing to life-threatening events. Pediatric head and neck infections can be difficult to recognize; emergency clinicians must know the signs and symptoms of head and neck infections for early diagnosis and urgent management in order to prevent complications and decrease hospitalization rates. This issue reviews presenting signs and symptoms of pediatric head and neck infections, discusses when diagnostic studies are indicated, and offers evidence-based recommendations for management. Conditions reviewed include mastoiditis, sinusitis, Ludwig angina, peritonsillar abscess, retropharyngeal abscess, Lemierre syndrome, and acute suppurative thyroiditis.

Acute suppurative klebsiella thyroiditis: a case report.

Acute suppurative thyroiditis and thyroid abscess are extremely rare disorders. The most common pathogens causing acute suppurative thyroiditis are Gram-positive bacteria, including staphylococcal and streptococcal species. Thyroid abscess is mostly located in the left thyroid lobe. We report the case of a 75-year-old female patient with acute suppurative thyroiditis and right lobe thyroid abscess caused by Klebsiella spp. The patient had a firm, livid, hardly mobile cervical swelling. Axial computed tomography image showed soft-tissue swelling, an abscess in the right thyroid lobe and swelling of the thyroid gland. The diagnosis was established on a smear culture result. The patient was diabetic and had been operated on for goitre fifty years before. On indirect laryngoscopic examination, the patient was found to have right vocal cord paralysis. Infection and abscess resolved following surgical drainage and treatment with intravenous antibiotics, while the vocal cord paralysis persisted. Diabetes mellitus and previous thyroid surgery, in which sutures were used with unresorptive material, might have been the precipitating factors for the patient to acquire this unusual infection.

Management of thyroid gland abscess. / Manejo del absceso de la glándula tiroides.

BACKGROUND: Thyroid abscess or acute suppurative thyroiditis is an unusual clinical condition. We present our experience with cases attended over 41 years. MATERIALS AND METHODS: A retrospective study was performed on these patients reviewing their epidemiological characteristics and the diagnostic and therapeutic manoeuvres chosen for them all, as well as their clinical outcome. A group of 9 males and 5 females was studied, with ages ranging from 19 to 68 (mean of 40.6±15.4). These patients suffered 22 acute episodes, and 2 patients each had 4 episodes. RESULTS: Suppurative thyroiditis comprised 0.29% of the neck abscesses. Fine needle aspiration was performed in 13 cases to evacuate the collection and isolate the aetiological agent. Mycobacterium tuberculosis and Staphylococcus aureus were the most frequently identified. Nine patients underwent ultrasound and 7 computed tomography imaging studies. Surgery was the option for 10 patients, including drainage for 7, thyroidectomy for 4 and hemithyroidectomy for the remaining 2. Systemic or intralesional antibiotics and sclerosis of the gland were also carried out. Although one case presented with hyperthyroidism and thyrotoxicosis in the acute phase, definitive hypothyroidism was observed in 5 patients at 6 months following discharge. The rate of success was 100%. CONCLUSION: Thyroid gland suppuration is a very infrequent circumstance in neck pathology, and the options for its treatment are varied, from conservative to invasive techniques according to the microbial and radiologic findings.

Suppurative thyroiditis in children: a management algorithm.

OBJECTIVE: To elucidate the etiology of suppurative thyroiditis in children and recommend a management algorithm. METHODS: Case series of 5 pediatric patients with a diagnosis of suppurative thyroiditis seen between January 1999 and April 2007. RESULTS: All 5 patients primarily presented with left-sided intrathyroidal abscesses. The number of infections from first presentation to the time of definitive diagnosis ranged from 1 to 5. Three patients underwent incision and drainage of the abscess once, and 2 had the procedure performed 3 times. Barium swallows identified a piriform sinus tract on the left side in 2 of the 5 patients. Telescopic hypopharyngoscopy identified the internal opening in all 5. Three were managed with complete excision of their tracts and 2 with cauterization of the internal opening with silver nitrate. All 5 are currently asymptomatic. CONCLUSIONS: Suppurative thyroiditis is a very rare infection in children. A left-sided intrathyroidal abscess should immediately arouse suspicion of a piriform sinus tract. Barium swallows may identify the etiology in some cases. Definitive diagnosis requires a hypopharyngoscopy, with detailed telescopic examination of the left piriform fossa apex. Endoscopic chemical cautery of the internal opening is a safe and effective technique, with very low morbidity, and has the potential for cure.

Thyroid Abscess In Children: And The World Gets Stranger.

The eminent feature of the thyroid gland in its resistance to infection by virtue of a rich blood supply and lymphatic drainage. Concomitantly, high iodine content is also bactericidal. Acute suppurative thyroiditis, which leads to primary thyroid abscess, is an unusual type of head and neck infection. And above all, if it is in a paediatric age; it is quite rare. We have the opportunity to present such a noticeable case which was treated successfully by oral antibiotic therapy.

Acute Suppurative Thyroiditis with Thyroid Abscess and Bilateral Pneumonia: A Case Report.

Acute suppurative thyroiditis (AST) leading to thyroid abscess is a rare clinical entity. The aim of this article is to demonstrate a case of severe bilateral pneumonia which originated from a thyroid abscess. The authors report the case of a 57-year-old woman with severe bilateral pneumonia of thyroid origin. The patient had a painful throat and dysphagia for 2 or 3 days. She also had a history of mild fever and hard breathing with a discreet cough 7 days prior to hospital admission. In the past few months, the patient had frequent pneumonias. The patient was treated with a culture-appropriate antibiotic and total thyroidectomy. Primary recommendations for treatment of complicated infections of thyroid origin consider a multidisciplinary approach. Recurrent pneumonia in patients with thyroid nodules may be the result of thyroid inflammation, and, in such patients, neck ultrasound should be conducted as part of the diagnostic workup.

Acute suppurative thyroiditis secondary to urinary tract infection by E. coli: a rare clinical scenario.

A 60-year-old woman with diabetes and symptomatic urinary tract infection presented to us with a painful neck swelling for 2 weeks. We discuss diagnostic and management issues in acute suppurative thyroiditis caused by Escherichia coli.

Aspiration with or without lavage in the treatment of acute suppurative thyroiditis secondary to pyriform sinus fistula

ABSTRACT Objective There is currently no consensus regarding the optimal management of acute suppurative thyroiditis (AST) secondary to pyriform sinus fistula (PSF). To investigate the benefits and adverse events of aspiration with or without lavage for the treatment of AST secondary to PSF. Subjects and methods This was a retrospective analysis of consecutive patients with AST secondary to PSF who were admitted at the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University between August 2012 and December 2018. Clinical information, procedural data, and imaging data were analyzed. Results Seven patients (five women; mean age, 16.9 ± 6.3 years; range, 8-26 years) were included. The patients most presented with anterior neck pain and swelling (n = 7), fever (n = 7), or odynophagia (n = 5). Six cases of AST occurred on the left side of the thyroid and 1 on the right. All patients had thyroid abscess. AST was diagnosed by ultrasound-guided needle aspiration cytology in all cases. PSF was diagnosed during the inflammatory stage in five patients and during the quiescent stage in two. All patients were treated with empiric antibiotics. Needle aspiration without lavage was performed in three cases. Needle aspiration with lavage was performed in four cases. Repeat aspiration was performed in three cases. All patients recovered completely, with no procedure-related complications. During 18.3 ± 7.8 months of follow-up, AST recurred in one case. Excision of the PSF was performed in another case. Conclusion Ultrasound-guided aspiration with or without lavage had a good treatment effect and without adverse events for the management of AST secondary to PSF.

Thyroiditis. Acute, subacute, and chronic.

Inflammatory diseases of the thyroid are collectively the commonest thyroid disorder. Individually, they range from the rare case of acute bacterial thyroiditis to the other end of the spectrum, the even rarer Riedel's thyroiditis. Relatively common thyroid inflammatory diseases include the subacute thyroiditis syndromes. Of particular interest to endocrinologists is that both subacute granulomatous (painful) thyroiditis and subacute lymphocytic (painless) thyroiditis are very similar in terms of clinical course, although most likely have different etiologies. Nevertheless, their similarities suggest the possibility that there may be etiologic heterogeneity for the syndromes. From a clinical standpoint, it is essential to differentiate subacute painless thyroiditis from Graves' disease, because these two disorders also may mimic each other, yet only Graves' disease requires specific therapy. Chronic lymphocytic (Hashimoto's) thyroiditis, the commonest of the thyroiditides, presents with goiter and either hyperthyroidism (uncommon), hypothyroidism (common), or euthyroidism (most common). When L-T4 therapy is used in the treatment of Hashimoto's thyroiditis, the physician must be alert to the possibility of excess thyroid hormone administration. Sensitive TSH measurements help to avoid this therapeutic pitfall.

Acute suppurative thyroiditis with bilateral piriform sinus fistulae.

Although there are many possible routes of infection in AST, the clinician must be aware of a possible fistula between the piriform sinus and the perithyroidal space--especially in patients with recurrent episodes of AST. Diagnosis of this congenital tract requires a high index of suspicion and radiographic demonstration by a barium swallow or endoscopic visualization. Effective treatment of AST with intravenous antibiotics and appropriate surgical intervention have greatly reduced the mortality and secondary complications. Complete fistulectomy, however, is required for permanent cure.

Inflammatory thyroid disorders.

Inflammatory disorders of the thyroid, including autoimmune thyroiditis, are among the most common endocrine abnormalities encountered in clinical practice. The association of pain with these disorders, however, is relatively uncommon. Despite this observation, painful thyroid disorders comprise a significant component of the spectrum of thyroid disease. A rational approach to such patients, including history, physical examination, laboratory evaluation, radionuclide or ultrasonographic imaging, and fine needle aspiration biopsy, will allow the appropriate diagnosis to be made in the vast majority of cases.