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.

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.

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.