Acute suppurative thyroiditis due to Streptococcus anginosus leading to sepsis and acute respiratory distress syndrome: a case report

SUMMARY Acute suppurative thyroiditis (AST) is a rare but potentially life-threatening thyroid disease with a high mortality if left untreated. Thus, differentiation from other thyroid disorders is highly important in clinical practice. A 22-year-old male patient was admitted to a tertiary care hospital with cervical pain, palpitations, thyrotoxicosis, and an inhomogeneously enlarged right thyroid lobe. In view of the clinical findings, subacute thyroiditis (SAT) was suspected and treatment with glucocorticoids was started. After initial amelioration, the patient developed cervical erythema, fever, and recurrent pain. A CT scan showed extensive phlegmonous inflammation and abscess formation, suggestive of AST. We started immediate empiric antibiotic therapy and performed surgical drainage of the abscess formations. Subsequently, the patient developed hypoxic respiratory failure, leading to ICU admission and intermittent need for non-invasive ventilation. Blood and abscess cultures were positive for Streptococcus anginosus. If left untreated, AST represents a potentially life-threatening disease. Thus, in clinically doubtful cases, liberal further assessment by means of cervical CT scans or fine needle aspiration biopsy are strongly advised.

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

Acute Suppurative Thyroiditis Secondary to Tuberculosis with Superimposed Bacterial Infection: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#Acute suppurative thyroiditis is a rare and potentially fatal condition. We present a case of an 18-year-old Malay female who presented with one-week history of painful right sided neck swelling, fever and odynophagia. Neck CT confirms ruptured multiloculated abscess with posterosuperior extension into prevertebral space. Pus and tissue cultured Streptococcus anginosus and Eikenella corrodens with positive TB PCR. She responded well to ampicillin/sulbactam and anti-tuberculosis treatment with no evidence of residual collection from ultrasound.

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.

Acute spontaneous suppurative thyroiditis caused by Eikenella corrodens presented with thyrotoxicosis / Tireoidite supurativa espontânea aguda causada por Eikenella corrodens acompanhada de tireotoxicose

ABSTRACT Acute suppurative thyroiditis is a very rare and life-threatening endocrine emergency. Thyrotoxicosis is a rare condition accompanying acute suppurative thyroiditis. While the majority of the cases in the literature are caused by different reasons, spontaneous development is very rare. We present a patient with acute suppurative thyroiditis who presented to our clinic with thyrotoxic findings, and we compared the case to the literature. A 31-year-old male patient was admitted to our clinic with a complaint of progressive neck pain, swelling and redness on midline neck, fever, and palpitations. On physical examination, swelling, redness and tenderness were detected on the neck region that was consistent with the thyroid location. He presented with tremor on the hands, tachycardia and agitation. Thyroid function tests were compatible with thyrotoxicosis, but there were findings supporting the presence of infection in biochemistry tests. On his radiological evaluations, a heterogeneous lesion divided with small septs was observed, with consolidation areas in the left thyroid lobe. In fine needle aspiration biopsy, 2mL of purulent fluid could be aspirated due to the presence of small, separated consolidation areas. He initiated on antibiotic therapy, propranolol, steroid and symptomatic treatment. Eikenella corrodens was detected on the culture antibiogram. Antibiotic therapy was continued for 14 days due to less symptoms and better biochemical values. After treatment, the patient had normal thyroid function, had relief of fever and redness of the neck, and was followed-up. It should be kept in mind that acute suppurative thyroiditis may develop spontaneously with the findings of thyrotoxicosis, with no risk factors.

RESUMO A tireoidite supurativa aguda é uma emergência endócrina muito rara e com risco de vida. A tireotoxicose é uma doença rara, que acompanha a tireoidite supurativa aguda. A maioria dos casos descritos na literatura tem diferentes causas, mas o desenvolvimento espontâneo é muito raro. Relatamos o caso de um paciente com tireoidite supurativa aguda, que veio a nossa clínica apresentando achados tireotóxicos, e o comparamos com a literatura. Trata-se de paciente do sexo masculino, 31 anos, que foi internado em nossa clínica com queixa de dor progressiva, edema e vermelhidão na linha média do pescoço, febre e palpitações. Ao exame físico, foram observados edema, vermelhidão e sensibilidade à dor na região do pescoço, consistente com a localização da tireoide. Apresentava tremor de mãos, taquicardia e agitação. Embora os exames de função tireoidiana fossem compatíveis com tireotoxicose, houve achados que sustentavam a presença de infecção nos exames bioquímicos. Nas avaliações radiológicas, observou-se lesão heterogênea dividida por pequenos septos, com áreas de consolidação no lobo tireoidiano esquerdo. Na biópsia por aspiração por agulha fina, foi possível aspirar apenas 2mL de líquido purulento, devido à presença de pequenas áreas de consolidação separadas umas das outras. Iniciaram-se antibioticoterapia, administração de propranolol e esteroides, além de tratamento sintomático. Eikenella corrodens cresceu na cultura do antibiograma. A antibioticoterapia foi estendida por 14 dias devido à melhora nos sintomas e dos valores bioquímicos. Após o tratamento, o paciente se apresentava eutireoideo, com melhora na febre e na vermelhidão no pescoço, sendo então acompanhado. Deve-se ter em mente que a tireoidite supurativa aguda pode se desenvolver espontaneamente com achados de tireotoxicose, sem nenhum fator de risco.

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.

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.

Refractory acute suppurative thyroiditis secondary to pyriform sinus fistula

Acute suppurative thyroiditis is a rare disease because the thyroid gland is remarkably resistant to infection. We present a 2-year-old girl with refractory acute suppurative thyroiditis due to a pyriform sinus fistula (PSF). She complained of fever and painful anterior neck swelling. Her condition did not completely improved by multiple parenteral antibiotics along with incision and drainage. Barium esophagogram to detect PSF demonstrated no specific finding. Computed tomography scan showed air bubble superior to the left thyroid gland which indicated a possible fistula connected to the pyriform sinus. An intraoperative laryngoscopy revealed a 2-mm-sized fistula opening. The fistula was successfully treated by chemocauterization with 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.

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.

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.

A Case of Actinomycotic Thyroiditis in an Adult with Piriform Sinus Fistula

Acute suppurative thyroiditis is an uncommon infectious thyroid disease affecting mainly children and young adults. The route of infection is frequently a pyriform sinus fistula. The major pathogens responsible for acute bacterial suppurative thyroiditis are the Streptococcus and Staphylococcus species. In contrast, Actinomyces species are a very rare cause of acute suppurative thyroiditis. We experienced a case of a 23-year-old man who has presented general weakness and neck pain. Thyroid ultrasonography showed an ill-defined area of heterogeneous hypoechogenicity in the left lobe of the thyroid gland. Histologic examination by fine needle aspiration demonstrated gram-positive, filamentous-like organisms with branching hyphae and characteristic sulfur granules. Barium esophagogram showed a linear barium-filled track at the left pyriform sinus. We report a case of actinomycotic thyroiditis in a young adult with pyriform sinus fistula along with a brief review of related literature.

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.

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 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.

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.