Acute suppurative thyroiditis misdiagnosed as subacute thyroiditis with deep neck space infections and Lemierre's syndrome: a case reported and literature reviewed / 中国综合临床

Acute suppurative thyroiditis(AST) is a rare thyroid disease, mostly caused by infections such as Staphylococcus aureus, and it is difficult to distinguish from subacute thyroiditis(SAT) at the beginning of the disease. Here we report the clinical data of a young male patient who was initially misdiagnosed as SAT, but was clinically diagnosed as AST with DNSIs accompanied by LS. The clinical features and treatment, combined with related literature, aim to enhance clinicians' understanding of this disease.

Acute suppurative thyroiditis with Graves disease - A very rare association

SUMMARY Acute suppurative thyroiditis is an uncommon disorder caused by a bacterial infection, usually presenting with normal thyroid function. It is a serious condition that requires a prompt diagnosis and treatment with antibiotics and supportive measures. A 62 years-old female presented with a painful cervical induration and odynophagia a week after a fish bone had been removed from her pharynx. She was febrile, and tachycardic and, on physical examination, a painful thyroid mass was detected. High inflammatory parameters and thyrotoxicosis were confirmed: thyroid stimulating hormone (TSH) < 0.01 mIU/L (normal range [NR] 0.27-4.2); free thyroxine (FT4) 3.86 ng/dL (NR 0.9-1.7) and anti-TSH receptor antibodies (TRABs) 5.3 U/L (NR < 1.5). Thyroid scintigraphy showed a diffuse uptake of the thyroid parenchyma suggesting Graves disease. Cervical ultrasonography revealed an abscess of the left thyroid lobe of 36 × 36 mm and fine needle aspiration biopsy (FNAB) with partial drainage was performed. Staphylococcus aureus and Streptococcus viridans were isolated, and directed antibiotic therapy was started. Clinical improvement was observed as well as a decrease of inflammatory parameters and the patient was discharged after 9 days of hospitalization. Eighteen days after discharge, thiamazole was initiated due to persistent thyrotoxicosis. Complete resolution of the abscess was documented within 6 months and the patient became euthyroid under thiamazole one year after initial presentation. To our knowledge, this is the third case reporting an association between acute thyroiditis and Graves disease. Furthermore, this is the first case detailing the simultaneous diagnosis of acute suppurative thyroiditis caused by a foreign body and Graves disease.

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.

A Case of Piriform Sinus Fistula Complicated with Suppurative Thyroiditis Treated with Chemocauterization Using Trichloroacetic Acid / 계명의대학술지

A 23 months-old girl visited the hospital because of fever and left neck mass. She was diagnosed as acute suppurative thyroiditis with piriform sinus fistula. Thyroid sonography showed perithyroidal abscess formation and thyroid scan showed decreased uptake of Tc-99m pertechnate of both thyroid glands. Magnetic resonance imaging of neck showed abscess cavity extending to the swollen left thyroid gland. And there was tiny fistula between thyroid and piriform sinus in the barium esophagogram. Streptococcus gordonii was isolated on needle aspiration culture. We report a case of piriform sinus fistula of the neck complicated with suppurative thyroiditis. The fistula was treated with chemocauterization using trichloroacetic acid.

A Case of Acute Suppurative Thyroiditis Complicated by Hypocalcemia / 대한내과학회지

We report a case of acute suppurative thyroiditis complicated by idiopathic hypoparathyroidism. The patient was a 49-year-old female who visited our clinic with a painful goiter on the left lobe of the thyroid gland. She was hypocalcemic, which was accompanied unusually by acute suppurative thyroiditis. She also suffered from tetany of both hands and legs. She had undergone a right subtotal thyroidectomy at another hospital 23 years previously due to a benign thyroid nodule. Intact parathyroid hormone (PTH) levels were increased, but other laboratory findings were normal. No special treatment was administered for the acute suppurative thyroiditis, except antibiotics, to observe its natural course. Her PTH levels decreased and serum calcium returned to normal. The complication of acute suppurative thyroiditis suggested the possible involvement of idiopathic hypoparathyroidism.

Approach to the patient with acute suppurative thyroiditis: diagnosis and treatment / 中华内分泌代谢杂志

Acute suppurative thyroiditis (AST) is a rare non-specific infectious disease of thyroid gland.The signs and symptoms of AST may mimic those of a variety of noninfectious inflammatory conditions or other anterior neck infectious diseases.AST is a progressive disease and is also potentially life threatening if devoid of prompt diagnosis and proper treatment.Herein,we report a case in order to call attention to the diagnosis and treatment of AST.

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.

Tiroiditis aguda piógen: revisión del tema a propósito de un caso / Acute pyogenic thyroiditis: case report and review

La tiroiditis aguda piógena o supurada es considerada una entidad rara y se caracteriza por signos inflamatorios y colección purulenta a nivel tiroideo. Se presenta el caso de una niña de 9 años, vista en el Hospital de Apoyo Juli, en el departamento de Puno, que presentó bocio doloroso, disfagia, fiebre y leves signos de hiperfunción tiroidea. La ecografía mostró una colección en el lóbulo derecho y en la punción tiroidea se obtuvo material purulento. El tratamiento se realizó con ceftriaxona, 50 mg/kg/d, clindamicina, 30 mg/kg/d y drenaje quirúrgico. La evolución de la paciente fue satisfactoria.

Acute suppurative thyroiditis is currently considered a rare entity and it is characterized by inflammatory signs and a collection of pus in the thyroid. We report a 9 years-old girl that was seen at Hospital de Apoyo Juli in the department of Puno, in which a tender goiter with dysphagia, fever and light signs of thyroid hyperfunction were present. Ultrasonogra-phy showed right lobule collection and the punction revealed purulent material. Treatment was done with cephtriaxone 50 mg/kg/d and clindamycin 30 mg/kg/d, besides of surgical drainage. The patient evolution was satisfactory.

A Child of Acute Suppurative Thyroiditis with Transient Thyrotoxicosis / 대한소아내분비학회지

Acute suppurative thyroiditis is an uncommon disease of thyroid, as thyroid gland is remarkably resistant to infection. In children, the most common route of infection is from a pyriform sinus fistula and then the inflammation spreads from the sinus to the perithyroidal space. It is important to differentiate acute suppurative thyroiditis with thyrotoxicosis from subacute thyroiditis. And if left untreated, acute suppurative thyroiditis can lead to thyroid abscess formation. A 11-year-old girl presented with acute illness of fever and tender neck swelling. Thyroid ultrasonogram and ultrasono-guided needle aspirated cytology confirmed acute suppurative thyroiditis. Although on computed tomography (CT) scan suggested acute suppurative thyroiditis due to pyriform sinus fistula, there was no evidence of fistula formation between thyroid and pyriform sinus on barium esophagogram. After treatment with antibiotics, she displayed clinical improvement and was discharged without complication. Here we report a child of acute suppurative thyroiditis with transient thyrotoxicosis controlled with antibiotics with literature review.

Recurrent Acute Suppurative Thyroiditis due to Piriform Sinus Fistula

Acute suppurative thyroiditis is an uncommon condition because the thyroid gland is remarkably resistant to infections. In children, anatomic defects, such as a left piriform sinus fistula, predispose subjects to this infection. The number of reports on acute suppurative thyroiditis and an anterior neck abscess due to piriform sinus fistula have recently increased. The sinus may be overlooked for years, with the patient receiving multiple procedures before a proper diagnosis is made and the condition correctly treated. Herein, we report our experience of a case of recurrent suppurative thyroiditis associated with piriform sinus fistula, and reviews the embryological development of the sinus, as well as clinical symptoms and treatment of acute suppurative thyroiditis.

A Case of Thyroid Abscess Associated with Lymphocytic Thyroidits / 대한내분비학회지

No Abstract available.

A Case of Acute Suppurative Thyroiditis as a Complication of Acupuncture in Patient with a Benign Thyroid Nodule / 대한내분비학회지

Acute suppurative thyroiditis is an uncommon disease, and usually affects patients with preexisting thyroid gland pathology. Penetrating injury could provide an acquired channel for the infection to spread into the relatively infection-resistant thyroid gland. We describe the first case of acute suppurative thyroiditis, as a complication of acupuncture, in a patient with a benign thyroid nodule. A 54-year-old male received acupuncture on his neck for the treatment of a previously diagnosed thyroid nodule. Four days after the acupuncture, the patient was admitted due to severe pain of the anterior neck and odynophagia. Fever and tenderness over the thyroid gland were observed. Burkholderia cepacia was isolated from a culture dish of aspirate of the thyroid gland. A neck computed tomography scan showed an abscess in the thyroid gland. Antibiotic treatment, and repeated drainage of the abscess, ameliorated the symptoms of infection. Two weeks after admission, the patient was discharged without sequela. Acupuncture should be considered as a kind of penetrating injury, which may induce acute suppurative thyroiditis.

Fourth Branchial Pouch Sinus 1 Case / 대한이비인후과학회지

A fourth branchial pouch sinus is very rare disease with less than 35 cases reported in the literature since they were first described by Tucker and Skolnick in 1972. It is a congenital anomaly that begins in the apex of the piriform sinus, and exits the pharynx inferior to the fourth arch derived from the superior laryngeal nerve, cricopharyngeus, and thyroid cartilage, and descends in the neck lateral to the trachea and esophagus. It is most frequently manifested by recurrent episodes of neck abscess or acute suppurative thyroiditis. This lesion usually becomes symptomatic before the age of 10 years and is found in the left sides in 93%. Proper diagnosis and appropriate surgical management depend on thorough understanding of embryology and anatomy, and keen suspicion. We report of a case of fourth branchial pouch sinus in a 12-year old male, who was treated with thyroid lobectomy, excision of sinus tract, and laser ablation of interanl opening.

A Case of Acute Suppurative Thyroiditis in Pediatric Patient

Acute suppurative thyroiditis(AST) and thyroid abscess are uncommon in children. The remaining pyriform sinus tract with fistula is well known underlying abnormality of AST in pediatric patients. AST or thyroid abscess in children can be caused by infection through pyriform sinus fistulae which usually originate from the tip of the left pyriform sinus. The left-sided predominance of involvement and frequent recurrence are characteristic findings. We present a case history that include a left sided thyroid lesion of a 5-year-old girl and radiologic evidence of pyriform sinus fistula. The pus culture revealed the bacterial etiology as Staphylococcus epidermidis. Our discussion focused on the etiology and the management of AST and thyroid abscess in children.

A Case of Acute Suppurative Thyroiditis / 대한소아내분비학회지

Acute suppurative thyroiditis is a rare because of high resistance to bacterial infection of thyroid gland, which is rich vascularity and lymphatic drainage, a high iodine content and complete encapsulation. The common clinical manifestations are fever, neck pain and localized mass of thyroid area. This thyroiditis is more common in left thyroid lobe. The most important causal microorganism are staphylococci and streptococci, with frequent isolation of mixed flora and anaerobes. Diagnosis was easily made by typical clinical manifestation, ultrasonography, thyroid imaging and fine needle aspiration. Treatment usually consist of appropriate antibiotic therapy and surgical drainage when abscess formation develops. We report a typical case of acute suppurative thyroiditis in 1 year old female infant with brief review of literatures.

Pyriform sinus fistula

Three patients had cervical draining sinus communicating with the pyriform sinus and one patient had acute suppurative thyroiditis resulting from infection through the pyriform sinus. There was a moderate to severe perithyroidal inflammation in all 4 cases. The age of onset ranged from 7 to 18 years old (mean; 12) but that of confirmation 9, 15, 18 and 67 years of age. Three of the patients were male and 3 of the cases involved the left side. All patients had suffered from several recurrences of cervical abscess, ranged from 2 to 7 times (mean; 4). Characteristic clinical features included 1) onset at a young age 2) frequent recurrence unless the fistula was extirpated completely 3) presenting with cervical draining sinus after repeated incision and drainage. It is supposed that the fistula is a route of infection mainly in the perithyroidal space and subsequently into the thyroid gland. When the fistula communicates directly with the thyroid gland, it can cause primary acute suppurative thyroiditis. Chronic cervical draining sinus with histories of repeated incision and drainage may be the clue to the diagnosis. A barium paste swallow study is the radiologic procedure of choice and complete removal of the fistula is the treatment of choice.

Three cases of acute suppurative thyroiditis in children

Acute suppurative thyroiditis is uncommon in children. The relative rarity of thyroid infection is thought to reflect its complete fibrous encapsulation, generous vascular and lymphatic supply and high local iodine level. The bacterial involvement include the normal oropharyngeal microflora, and broad spectrum antibiotic therapy including anaerobic coverage should be utilized initially. We have experienced three cases of acute suppurative throiditis. All of them had painfull swelling on anterior cervical area and diagnosed by clinical and radiological features. Since two of them occured repeatedly, we report with brief review of literatures.