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  • • Sudden onset

    • Often follows an upper respiratory tract infection




  • • Rare condition

    • 50% of patients have preexisting thyroid disease

    • Peak incidence in childhood or young and middle-age adults


Symptoms and Signs


  • • Acute neck pain, exacerbated by neck extension

    • Dysphagia

    • Fever, chills

    • Neck enlargement

    • Warmth and erythema

    • Hemoptysis

    • Cervical lymphadenopathy


Laboratory Findings


  • • Leukocytosis

    • Normal thyroid function


Imaging Findings


  • • Barium swallow (if suspect piriform sinus) demonstrates fistulous tract

    • Areas of decreased uptake on thyroid scan (if associated abscess)

    • Partially cystic mass seen on thyroid US


  • • Percutaneous aspiration, with Gram stain and culture often yields diagnosis

    • Most common organisms are:

    • -Streptococci




    • May be associated with a piriform sinus fistula

    • Extremely rare causes include:

    • -TB





    • Infection usually arises from drainage from local structures but can also be hematogenously spread or after direct trauma

    • Blood-tinged sputum suggest tracheal involvement


Rule Out


  • • Chronic suppurative thyroiditis

    • De Quervain thyroiditis


  • • History and physical exam

    • Needle aspiration, with Gram stain and culture of aspirate


  • • Primary treatment is antibiotics




  • • Thyroid abscess drained operatively




  • • Thyroid abscess

    • Cysts communicating with the piriform sinus or trachea (surgery to excise this fistula should be done after the infection has been completely eradicated)




  • • Antibiotics are indicated in all cases


Treatment Monitoring


  • • Improvement should occur within 48-72 hours of starting antibiotics, with complete resolution after 2-4 weeks



Brook I: Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg 2004;62:1545.  [PubMed: 15573356]

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