[An unusual surgical disease of the thyroid: suppurative thyroiditis].
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Abscess↗
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[Unusual case of acute suppurative thyroiditis].
Acute suppurative thyroiditis is an acute disease of the thyroid gland. In this paper the authors report a case of acute suppurative thyroiditis complicated by abscessual evolution in an addict patient study with ultra-sonography and treated with fine needle aspiration and antibiotic therapy. The patient reached our observation for a swelling of the neck. Ultrasonography showed diffuse hypoechogenicity in both thyroid lobes and mixed nodule with hyperechoic trabeculas inside. This nodule underwent fine needle aspiration (FNA) for cytologic and cultural evaluation. Diagnosis was acute suppurative thyroiditis. Ultrasonography presented features similar to other thyroid pathology (sub-acute thyroiditis, haemorrhagic cyst, thyroid lymphoma and anaplastic carcinoma). In our case none of the ultrasonographic features were diagnostic except hyperechoic trabeculas inside. Ultrasonographic features of acute suppurative thyroiditis are very rare in the literature. Ultrasonography and fine needle aspiration are the only methods that confirm this diagnosis.
Acute Disease↗
[Acute suppurative thyroiditis in a patient with prior subacute thyroiditis].
Acute suppurative thyroiditis is an uncommon thyroid disorder usually caused by bacterial infection. The most common route of infection is a fistula that originates from the fundus of the pyriform sinus. Pre-existing thyroid disease, most commonly nodular goiter, has been reported to be present in acute suppurative thyroiditis. A 44 year old man presented a subacute thyroiditis, resolved by nonsteroidal antiinflammatory treatment. One year later, the patient abruptly complained of fever and painful swelling in the thyroid region. A relapse subacute thyroiditis was diagnosed and prednisone treatment was started. A few days later owing to a worsening of the pain and of the clinical features the patient was referred to our department. He presented dysphagia and he was feverish, the overlying skin of the neck swelling was erythematous and warm. There was a neutrophilia (83.7%). Plasma FT4, FT3 and TSH were normal. Anterior neck region ultrasonography showed an enlargement of the left thyroid lobe with poorly defined shapes and inhomogeneous parenchyma while the right lobe of the gland was normal. The 131-I thyroid scan showed a large cold area in the upper part of the left thyroid lobe and preserved radionuclide uptake in the residual parenchyma. The RAIU was normal. We diagnosed acute suppurative thyroiditis and started antibiotics treatment. The day after the patient was still feverish and he gave out from the mouth a great quantity of sero-purulent material with a swelling reduction and improvement of the neck pain. Barium swallow examination did not show any fistula in the cervical esophagus. The fistula opening was demonstrated by indirect laryngoscopy in the postero-lateral side of hypopharynx.(ABSTRACT TRUNCATED AT 250 WORDS)
Abscess↗
Hyperthyroidism associated with acute suppurative thyroiditis.
Acute suppurative thyroiditis is a rare condition with potentially serious complications. It has been suggested that hyperthyroidism may be a feature in occasional cases but this has been poorly documented. We describe a patient in whom acute suppurative thyroiditis caused transient hyperthyroidism.
Acute Disease↗
[Pasteurella spp: a new microorganism to the cause of acute suppurative thyroiditis].
Acute suppurative thyroiditis is an uncommon disease due to local resistance of the gland to infection. Preexisting gland pathology and local anatomic abnormalities are predisposing factors. We present the first case described in the medical literature caused by Pasteurella spp after upper respiratory infection with insidious manifestations resembling subacute thyroiditis. The course was benign after surgical drainage.
Acute Disease↗
Fine needle aspiration cytology in the management of acute suppurative thyroiditis.
Acute suppurative thyroiditis (AST) is relatively uncommon. We report 11 such cases from a population residing in a goiter endemic zone of Northern India. The important contribution of fine needle aspiration cytology in confirming the diagnosis and management is emphasized.
Acute Disease↗
Acute suppurative thyroiditis.
Acute suppurative thyroiditis is a rare disease which may be confused with other, more common thyroid disorders. Gram-positive organisms such as Streptococcus, Staphylococcus, and Pneumococcus are most frequently responsible for this condition. Appropriate antibiotics should be selected to control local and systemic signs of infection. Incision and drainage of fluctuant areas are indicated. Thyroid function almost always returns to normal with eradication of infection.
Acute Disease↗
The CT findings of acute thyroiditis and acute suppurative thyroiditis.
Although acute thyroiditis often has a distinctive clinical presentation, this relatively uncommon entity can occasionally be confused with other inflammatory processes. In general, the earlier the diagnosis of acute thyroiditis is established, the lower is the frequency and severity of its attendant complications. Computed tomography (CT) is an extremely useful modality in establishing the diagnosis early because it can evaluate iodine content of the thyroid gland and provides more accurate mapping than ultrasound and nuclear medicine techniques. Three patients with acute thyroiditis--two with suppuration--are presented and the CT findings and clinical aspects of this disease are reviewed.
Acute Disease↗
[Subacute thyroiditis and concurrent suppurative thyroiditis in one case].
We report a 41 years old man admitted with a tender goiter, fever, thyrotoxic manifestations and atrial fibrillation. Laboratory confirmed the diagnosis of subacute thyroiditis and treatment with aspirin and propranolol was started, obtaining a rapid relief of symptoms and normalization of heart rate. On the tenth day after admission, severe dysphagia, dysphonia, irritative cough and further enlargement of the neck mass developed. Fine needle aspiration of the mass and thyroid ultrasound lead to the diagnosis of a thyroidal abscess, which was surgically excised, draining 250 ml of purulent material. Cultures were positive for Staphylococcus aureus. Patient was treated during 21 with cloxacilyn and discharged with normal thyroid function. Long term follow up has been uneventful.
Adult↗
Ultrasonography and fine needle aspiration cytology of acute suppurative thyroiditis.
Although acute suppurative thyroiditis is a rare disorder, from January. 1985 to December 1991, we observed 11 cases of acute suppurative thyroiditis in our hospital. All patients underwent thyroid ultrasonography and fine needle aspiration biopsy and cytologic evaluation of the specimens. In eight cases, pus cultures were positive, four of them grew Gram negative bacteria. Ultrasonographic finding showed either local or diffuse low to a very low echo density on both lobes. However, a cystic lesion was also found. Polymorphonuclear cells were the main elements in the smears from the thyroid aspirates. In conclusion, thyroid ultrasound with fine needle aspiration and cytology can assist in confirming the early diagnosis of acute suppurative thyroiditis.
Acute Disease↗
Nine cases of piriform sinus fistula with acute suppurative thyroiditis.
OBJECTIVE: Acute suppurative thyroiditis is a disease of an infection originated from the piriform sinus via congenital fistula. The purposes of this study are the establishment of accurate and necessary examinations for the diagnosis and necessary treatment for complete remission of this disease. METHODS: We reported nine cases with acute suppurative thyroiditis who were treated by operation. Preoperative examinations and operative procedures for nine cases were investigated. RESULTS: A congenital fistula was detected in seven of nine patients preoperatively, and in all seven patients, the fistula was detected during the operation. Serum thyroglobulin was elevated in four of five patients who were examined the serum level. Ultrasonogram was performed in eight cases, and localized swelling of the thyroid lobe was observed in all cases. No inflammatory recurrence was observed in eight cases, and recurrence was observed in one case where complete fistelectomy was not performed. CONCLUSION: Measurements of serum thyroglobulin, ultrasonography, and pharyngoesophagography were useful in the diagnosis of acute suppurative thyroiditis. Complete removal of the fistula with or without affected thyroid lobe is necessary to prevent recurrent suppuration.
Acute Disease↗
Impaired vocal cord mobility in the setting of acute suppurative thyroiditis.
BACKGROUND: Acute suppurative thyroiditis is an increasingly rare entity, accounting for less than 0.1% of thyroid surgery. This is the first report in the literature of acute thyroiditis causing a unilateral reversible vocal cord paralysis. METHODS: A 41-year-old woman was initially seen with a unilateral vocal cord paralysis resulting from acute suppurative thyroiditis. RESULTS: The vocal cord paralysis resolved following surgical drainage of the thyroid abscess and treatment with intravenous antibiotics. CONCLUSIONS: We present this case to emphasize the need for a complete and thorough head and neck exam including preoperative documentation of vocal cord mobility.
Acute Disease↗
Indications for thyroid needle biopsy: suppurative thyroiditis.
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Adult↗
Clinical characteristics and management of acute suppurative thyroiditis in children.
BACKGROUND: Acute suppurative thyroiditis is an uncommon disease in children. This paper describes the clinical characteristics and management of children with acute suppurative thyroiditis treated during a 15-year period at National Taiwan University Hospital. PATIENTS AND METHODS: From 1985 to 2000, acute suppurative thyroiditis was diagnosed in 11 previously healthy children (6 boys, 5 girls) at the Department of Pediatrics. Their mean age at diagnosis was 6.4 +/- 4.4 years. Leukocyte count, acute-phase reactants, thyroid function, and thyroid autoantibodies were assessed. Samples were taken by thyroid needle aspiration for cytology study and pus culture. Underlying pyriform sinus fistula (PSF) was demonstrated by barium esophagogram. RESULTS: Leukocytosis was noted in six cases (55%) and acute-phase reactants were elevated in eight cases (73%). Neither thyroid autoantibodies nor thyroid dysfunction was detected in any of the patients. Barium esophagogram detected PSF in eight of 10 patients examined. Five (45%) patients had recurrent suppurative thyroiditis before surgery. Cytology and pus cultures were available for 10 patients. Polymorphonuclear cells were the main findings in the smear from thyroid aspirates. Twenty-two organisms were isolated from six patients (60%). Streptococcus species (45%) and anaerobic organisms (41%) were the most common pathogens isolated. Mixed infection was detected in five of six children who had a causative microorganism identified. The microorganisms were all sensitive to amoxicillin-clavulanate. CONCLUSION: PSF plays a role in the pathogenesis of acute suppurative thyroiditis in children. Streptococcus species are the most common pathogens in acute suppurative thyroiditis. Our results suggest that amoxicillin-clavulanate is the drug of choice for the treatment of this disease.
Acute Disease↗
Salmonella brandenburg: a novel cause of acute suppurative thyroiditis.
A patient with suppurative thyroiditis due to infection with Salmonella brandenburg is reported. Localization of the infection occurred to a pre-existing thyroid nodule after Salmonella bacteremia. S. brandenburg was isolated in pure culture from the fluid obtained by needle aspiration of the suppurated thyroid nodule. Surgical drainage followed by subtotal thyroidectomy was required to cure the disease. No evidence of pyriform sinus fistula was found. Suppurative thyroiditis due to Salmonella ubiquitous serotypes is an extremely rare condition, and infection to the thyroid produced by S. brandenburg is reported now for the first time. Indeed, the isolation rate of S. brandenburg from all human sources is low, and this microorganism is an uncommon agent of bacteremia.
Adult↗
Mycobacterium avium intracellulare suppurative thyroiditis in a patient with Hashimoto's thyroiditis.
A case of suppurative thyroiditis occurring in a 72-year-old woman is reported. The clinical history of this woman, treated by tianeptine for mild exogenous affective disorder and by conventional insulin therapy for long-standing insulin-dependent diabetes, was remarkable for the pseudotumoral signs which led to the simultaneous diagnosis of hypothyroidism due to Hashimoto's thyroiditis and of mycobacterium avium intracellulare suppurative thyroiditis. To our knowledge, this is the second reported case of mycobacterium avium intracellulare thyroiditis. This case is also exemplary, given its occurrence in the absence of severe immunodepression, setting apart the mild impact on the immune system of affective disorder and of long duration's insulin-dependent diabetes.
Aged↗
Acute suppurative thyroiditis in children.
BACKGROUND: Acute suppurative thyroiditis in children is rare and is often related to a pyriform sinus fistula or thyroglossal duct remnant, especially when it is recurrent. METHODS: From January, 1985, through December, 2000, 15 children with acute suppurative thyroiditis were treated. Their clinical, laboratory and radiologic findings were reviewed and analyzed. RESULTS: There were 8 girls and 7 boys, with a mean age at diagnosis of 6.1+/-2.9 years (range, 1.5 to 9.8). A thyroid mass was present on the left in 13 and on the right in 2 (P < 0.05). Fever, neck pain and swelling were the most common symptoms and signs. Seven patients (46.7%) had recurrent disease. Needle aspiration for Gram stain and bacterial cultures were done, and pathogenic organisms were identified on culture in 8 patients but were found only on Gram stain in 2 patients. In one-half of the patients with positive cultures, mixed pathogens were found. The most common organisms isolated were streptococcal species (50%). Barium esophagography was performed in all patients, and 5 (33.3%) had a pyriform sinus fistula on the left. Only 1 of the recurrent patients had a fistula. Thyroid scans were performed in 13 patients, of whom 12 (92.3%) had decreased radioactive uptake. Thyroid function tests were normal in all 15. CONCLUSIONS: Acute suppurative thyroiditis is usually caused by oropharyngeal flora, resulting in mixed pathogens on culture. Broad spectrum antibiotics should be given once cultures have been obtained. Imaging studies might be helpful in the diagnosis of acute suppurative thyroiditis.
Acute Disease↗
[Acute recurrent suppurative thyroiditis in childhood].
Acute suppurative thyroiditis in children is very rare and has been reported in only six cases. We describe a 4 1/2 year old girl who presented with acute suppurative thyroiditis of the left lobe. All thyroid function tests were normal but the radioisotope scan showed decreased activity over the upper pole of the left lobe. The child was treated with massive doses of antibiotics and gradually recovered. Three years later she presented with exactly the same findings in the left lobe of the thyroid. Thyroid function tests were again normal but repeated radioisotopic scan showed decreased activity over the left upper pole. Again she recovered gradually under massive antibiotic treatment. A follow up scan showed great improvement with almost complete recovery of activity in the left lobe.
Acute Disease↗