A Case of Acute Suppurative Thyroiditis with Thyrotoxicosis in an Elderly Patient

Acute suppurative thyroiditis (AST) is a rare condition, as the thyroid gland is relatively resistant to infection. Thyroid function tests are usually normal in AST. A few cases of AST associated with thyrotoxicosis have been reported in adults. We report a case of AST that was associated with thyrotoxicosis in a 70-year-old woman. We diagnosed AST with thyroid ultrasonography and fine needle aspiration of pus. The patient improved after surgical intervention and had no anatomical abnormality. Fine needle aspiration is the best method for the difficult task of differentiating malignancy and subacute thyroiditis from AST with thyrotoxicosis. Earlier diagnosis and proper treatment for AST might improve the outcome.

Case of concurrent Riedel's thyroiditis, acute suppurative thyroiditis, and micropapillary carcinoma

Riedel's thyroiditis (RT) is a rare chronic inflammatory disease of the thyroid gland. It is characterized by a fibroinflammatory process that partially destroys the gland and extends into adjacent neck structures. Its clinical manifestation can mask an accompanying thyroid neoplasm and can mimic invasive thyroid carcinoma. Therefore, diagnosis can be difficult prior to surgical removal of the thyroid, and histopathologic examination of the thyroid is necessary for a definite diagnosis. The concurrent presence of RT and other thyroid diseases has been reported. However, to our knowledge, the association of RT with acute suppurative thyroiditis and micropapillary carcinoma has not been reported. We report a rare case of concurrent RT, acute suppurative thyroiditis, and micropapillary carcinoma in a 48-year-old patient.

Acute Suppurative Thyroiditis Caused by Methicillin - Resistant Staphylococcus Aureus in Healthy Children / 대한소아내분비학회지

Acute suppurative thyroiditis is an uncommon condition because the thyroid gland is remarkably resistant to infection. In children, anatomic defects, such as a left piriform sinus fistula, predispose subjects to this infection. It is very important yet difficult to differentiate acute thyroiditis with thyrotoxicosis from subacute thyroiditis; and if left untreated, acute suppurative thyroiditis can lead to thyroid abscess formation. Bacterial infections with staphylococcus and streptococcus species are the most common causes of acute suppurative thyroiditis. Occasionally, the thyroid gland can be infected with fungi, parasites, or mycobacterium. An 8-year-old boy presented with acute fever and tender neck swelling. The patient was admitted to the hospital and was diagnosed with acute suppurative thyroiditis. The culture result of the drained fluid revealed methicillin-resistant staphylococcus aureus (MRSA). The patient's condition improved after the use of antibiotics and drainage. There was no evidence of fistula formation between the thyroid and the pyriform sinus on a computed tomography (CT) scan. Here we describe rapidly progressive thyroid abscesses caused by MRSA in healthy children.

Tiroiditis aguda supurada: Presentación de dos casos pediátricos

Objetivos: Presentar dos casos de niños con tiroiditis aguda supurada (TAS), cuadro infrecuente que produce dolor y afectación general del paciente. Realizar revisión de la literatura al respecto. Casos Clínicos: Se reportan dos casos: una niña y un niño, ambos con 3 años de edad al momento del diagnóstico, los cuales se presentan con afectación general, fiebre, dolor en región cervical y tumoración localizada en el lóbulo tiroideo izquierdo. El ultrasonido reportó aumento del volumen tiroideo con áreas hipoecogénicas que sugerían colección purulenta. Se comenzó la administración de oxacilina y amikacina, con buena respuesta en el primer caso y respuesta ausente en el segundo caso, quien ameritó cambio de tratamiento. El cultivo del material obtenido reportó negativo. Los pacientes mejoraron gradualmente una vez iniciada la antibióticoterapia. Conclusiones: La tiroiditis aguda supurada en la edad pediátrica debe considerarse una emergencia, debido al dolor y el estado tóxico que produce. Es usualmente causada por gérmenes de la flora orofaríngea, lo que puede resultar en una amplia variedad de gérmenes, y es necesaria la administración de antibióticos de amplio espectro mientras se espera el cultivo. Los estudios de imágenes son de gran ayuda para el diagnóstico.

Objectives: To report two cases of children with acute suppurative thyroiditis (TAS), an uncommon condition that causes pain and general involvement of the patient. A literature review is performed. Clinical Cases: A report of two cases: one girl and one boy, both with 3 years of age at diagnosis, who present with general involvement, fever, pain in cervical region and a localized tumour in the left thyroid lobe. The ultrasound reported increased thyroid volume with hypoechoic areas suggestive of purulent collection. The administration of oxacillin and amikacin were started, with good response in the first case and absent response in the second case, who merited change in treatment. The culture of material obtained reported negative. The patients gradually improved after the start of antibiotic therapy. Conclusions: Acute suppurative thyroiditis in pediatric patients must be considered an emergency because of the pain and toxic condition that occurs. It is usually caused by germs of oropharyngeal flora, which can result in a wide range of germs, and it is necessary to administer broad spectrum antibiotics while awaiting culture. Imaging studies are helpful for diagnosis.