Tiroiditis aguda supurada en una paciente con fístula del seno piriforme: presentación de un caso / Acute suppurative thyroiditis in a patient with a piriform sinus fistula: A case report

La tiroiditis aguda supurada es una entidad poco frecuente en pediatría; de origen infeccioso, cuya etiología más frecuente es bacteriana. Su presentación típica en niños es la aparición de una tumoración en la cara anterior del cuello, con signos de flogosis, dolorosa, caliente y eritematosa, que excursiona con la deglución, y puede o no estar acompañada de fiebre, disfagia o disfonía. En niños, las anomalías congénitas, principalmente la fístula del seno piriforme, predisponen a la infección de la glándula, por lo que es importante la resolución quirúrgica del defecto anatómico para prevenir las recurrencias. El diagnóstico rápido, basado en la clínica y los estudios por imágenes, es importante para comenzar en forma temprana con un tratamiento antibiótico adecuado.Se presenta una paciente de 3 años, previamente sana, con tumoración cervical izquierda dolorosa y asociada a fiebre. Durante la internación, se arribó al diagnóstico de tiroiditis aguda supurada secundaria a fístula de seno piriforme.

Acute suppurative thyroiditis is an infectious disease, uncommon in children, caused by various microorganisms, being bacteria the most frequently involved. The typical presentation includes the appearance of a tumor in combination with signs of swelling in the anterior aspect of the neck, which is painful on palpation and is associated with warmth and erythema. It usually moves with swallowing and the patient can suffer fever, dysphagia or dhysfonia. In children, congenital anomalies can lead to the gland's infection, and the surgical excision of them is important to prevent recurrency. A quick diagnosis, based on clinical manifestations and imaging studies, is necessary to install an adequate antibiotic treatment. We present the case of a 3-year-old patient, who was previously healthy, with a painful left cervical tumor associated with fever. During the hospitalization, we reached the diagnosis of acute suppurative thyroiditis caused by an underlying pyriform sinus fistula

Tiroiditis no-autoinmunes / Non-autoimmune thyroiditis

El término tiroiditis comprende un grupo de enfermedades de la glándula tiroides caracterizado por la presencia de inflamación, abarcando entidades autoinmunes y no-autoinmunes. Pueden manifestarse como enfermedades agudas con dolor tiroideo severo (tiroiditis subaguda y tiroiditis infecciosas), y condiciones en las cuales la inflamación no es clínicamente evidente, cursando sin dolor y presentando disfunción tiroidea y/o bocio (tiroiditis inducida por fármacos y tiroiditis de Riedel). El objetivo de esta revisión es aportar un enfoque actualizado sobre las tiroiditis no-autoinmunes cubriendo sus aspectos clínicos, diagnósticos y terapéuticos.

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.

Tiroiditis aguda en el lactante: presentación de caso / Acute thyroiditis in an infant: a case presentation

Se presenta el caso de un lactante de 7 meses de edad, masculino, quien se presentó con fiebre, síntomas respiratorios y aumento de volumen en la región anterior del cuello, doloroso y duro. Luego apareció ronquera y dificultad para tragar. En la ecografía tiroidea se observó lóbulo derecho e istmo normal. Lóbulo izquierdo heterogéneo, aumentado de tamaño, macro nodular con múltiples imágenes nodulares ecogénicas de diversos tamaños que ocupan la totalidad del lóbulo. Se interpretó como una tiroiditis aguda infecciosa; se inicia terapia antimicrobiana de amplio espectro por vía endovenosa. Se evolucionó con ecografías, se realizó biopsia por aspiración con aguja fina, se extrajo material purulento, se realizó incisión y drenaje. No se obtiene crecimiento bacteriano en el cultivo. La dosificación de hormona estimulante de tiroides y tiroxina fueron normales. El paciente presentó evolución favorable. La tiroiditis aguda es una patología que se puede presentar en niños de corta edad. Se debe iniciar terapia con antimicrobianos de amplio espectro.

A 7 months infant, masculine, that appeared with fever, respiratory symptoms and volume increase in the previous region of the neck, painful and hard arrived. In the thyroid echography it was observed right lobe and normal isthmus. Left lobe: heterogenous, increased of size, macronodular with multiple echogenic and nodular images of different sizes that occupy the totality of lobe. It was interpreted like an infectious acute thyroiditis, it was initiated a broad spectrum antimicrobial therapy administered intravenously. It was evolved with echography, a biopsy by aspiration was carried out being extracted purulent material, drainage and incision was carried out. Bacterial growth in the culture is not obtained. The thyroid function was normal. The patient presented favorable evolution. The acute thyroiditis is a pathology that can be presented in young children. A wide-ranging spectrum antimicrobial therapy most be initiated.

Tireoidite supurativa aguda com múltiplas complicações / Acute suppurative thyroiditis with multiple complications

A tireoidite supurativa aguda é uma desordem rara, mais frequentemente causada pelo Staphylococcus aureus ou Streptococcus pneumoniae, e atinge particularmente crianças com fístula do seio piriforme. Em adultos, a disseminação por via hematogênica a partir de foco infeccioso em orofaringe ou trato respiratório parece ser o principal mecanismo patogênico. Os sinais e sintomas iniciais da tireoidite aguda são semelhantes aos da faringite aguda e da tireoidite subaguda. Esse fato frequentemente retarda o diagnóstico dessa doença e aumenta o risco de complicações. Relatamos o caso de um paciente masculino de 28 anos, previamente saudável, que, após quadro de amigdalite, apresentou tireoidite aguda complicada por tireotoxicose, volumoso abscesso no lobo direito da tireoide, que se estendia à abertura superior do tórax com desvio da traqueia e compressão de grandes vasos, associado à trombose de veia jugular interna e sepse.

Acute suppurative thyroiditis is a rare disorder, most often caused by Staphylococcus aureus or Streptococcus pneumoniae, which affects particularly children with pyriform sinus fistula. In adults, the main pathogenic mechanism seems to be hematogenous dissemination from a focus of infection in the oropharynx or respiratory tract. The initial signs and symptoms of acute thyroiditis are similar to those of acute pharyngitis and subacute thyroiditis. This fact often delays diagnosis and increases the risk of complications. We report the case of a previously healthy, 28-year-old man who, after being affected by tonsillitis, developed suppurative thyroiditis complicated by thyrotoxicosis; a large abscess in the right lobe of the thyroid extending to the thorax introitus, which caused a trachea deviation and compressed large vessels; associated with internal jugular vein thrombosis, and sepsis.

Tireoidite supurativa aguda em paciente pediátrico / Acute suppurative thyroiditis in pediatric patient

A tireoidite supurativa aguda (TSA) é uma condição rara, potencialmente ameaçadora da vida, que acomete geralmente mulheres na idade adulta, sendo mais comum em pacientes com doença tireoideana pré-existente. Os autores apresentam o caso de uma paciente pediátrica, previamente hígida, com quadro clínico e exames complementares sugestivos de TSA durante sua internação no Hospital Universitário da Universidade Luterana do Brasil.

Acute suppurative thyroiditis (AST) is a rare life-threatening condition that usually affects women in adulthood, being more common in patients with pre-existing thyroid disease. The authors report the case of a previously healthy pediatric patient with clinical and laboratory tests suggestive of AST during her hospitalization at the University Hospital of the Lutheran University of Brazil.

Absceso tiroideo con fístula del seno piriforme: tres casos clínicos / Thyroid abscess with pyriform sinus fistulae: 3 clinical cases

Thyroid abscess is an infrequent, potentially life-threatening condition. It accounts for 0,1 to 0,7 percent of thyroid pathology, usually occurring in patients with preexisting disease of the gland or more commonly, associated to local anatomical defects, such pyriform sinus fistulae. Three cases of thyroid abscess in children are presented, in which no bacterial etiology was confirmed. Intravenous antibiotics were used, cefotaxime, cloxacillin or clindamicin. Recurrence was confirmed in 2 of them, and a pyriform sinus fistulae was demostrated by esophagogram.

El absceso tiroideo es un cuadro infrecuente y una emergencia endocrina potencialmente fatal. Representa el 0,1 a 0,7 por ciento de las patologías tiroideas. Habitualmente se produce en pacientes con patología preexistente de la glándula o más frecuentemente, asociado a defectos anatómicos locales, como una fístula del seno piriforme. Presentamos 3 casos de abscesos tiroideos en escolares. Recibieron tratamiento antibiótico endovenoso de amplio espectro, a pesar de lo cual dos de ellos recidivaron precozmente. En dos de ellos se demostró una fístula del seno piriforme con esofagograma que se manejó quirúrgicamente.

Forma atípica de tireoidite supurativa aguda em paciente pediátrico: relato de caso / Atypical form of acute suppurative thyroiditis in pediatric patient: case report

A tireoidite aguda é uma doença rara. Na infância associa-se principalmente a anormalidades congênitas com acometimento do lobo esquerdo. Na ausência de tireoidopatia preexistente, a função tireoidiana geralmente está normal. Relatamos um caso de uma menina, 6 anos de idade, com tumoração associada a sinais flogísticos na região cervical anterior há 15 dias acompanhada de leucocitose com desvio à esquerda, VSH e TSH elevados. Não havia história prévia de tireoidopatia. A ultra-sonografia da região cervical foi sugestiva de abscesso tireoidiano. Realizou-se antibioticoterapia e drenagem cirúrgica com boa resposta, porém posteriormente a paciente evoluiu com hipotireoidismo clínico. O esofagograma não detectou fístula do seio piriforme e a ultra-sonografia controle revelou heterogeneidade do parênquima, levantando-se a possibilidade de tireoidite de Hashimoto. A importância do caso deve-se à sua apresentação incomum: ausência de anormalidades congênitas, acometimento difuso da tireóide, alteração da função tireoidiana e provável tireoidite de Hashimoto como fator predisponente da tireoidite aguda.

Acute thyroiditis is an unusual disease. In pediatric patients it is usually associated with congenital abnormalities towards the unilateral envelopment of the left thyroid lobe. In general, in the absence of preexisting thyroid disease, the thyroid function is most often normal. It is here described a case of a six-year-old girl who had presented a mass with flogistic signs in the anterior neck region for fifteen days, together with leukocytosis and increased levels of VSH and TSH. There was no evidence of previous thyroid disease and the cervical ultrasonography suggested thyroid abscess. Intravenous antibiotic and surgical dranaige were done with a good response, however, the patient developed clinical hypothyroidism aftherwards . Barium swallow did not demonstrate pyriform sinus fistula and the follow-up ultrasonography revealed heterogeneous internal texture suggesting Hashimoto's Thyroiditis. The relevance of this case is due to its unusual findings: the absence of congenital abnormalities, bilateral envelopment of thyroid lobes, hypothyroidism and a probable Hashimoto's Thyroiditis as a predisposing factor for acute thyroiditis.

Tiroiditis aguda supurada en un paciente pediátrico / Acute suppurative thyroiditis: report of a pediatric case

Acute suppurative thyroiditis (AST) is an uncommon condition because thyroid gland is remarkably resistant to infections. In children, anatomic defects such as a left pyriform sinus fistula or a thyroglossal duct remnant predispose to this infection. Once the diagnosis is confirmed by ultrasound or computed tomography, antimicrobial therapy based on the culture and Gram staining must be started. After two or three weeks of treatment, predisposing anatomic defects must be sought cautiously. We report a 13 years old girl presenting with cervical pain and fever. A cervical ultrasound showed an enlarged thyroid lobule with hypoecogenic zones that suggested a supurative collection. Cefotaxime and cloxacillin were started. A needle aspiration of the collection obtained a purulent material. The culture of this material yielded a Streptococcus Pneumoniae. The clinical condition of the patient improved and she was discharged in good conditions. Two months later a contrast esophagus X ray did not show predisposing anatomic defects.

Isolation of Salmonella paratyphi A from thyroid abscess--a case report.

S. paratyphi A isolated from aberrant site i.e. thyroid abscess which is an unusual manifestation of focal salmonella infection. It is reported for its rare complications.