Thyroiditis, Acute Suppurative

• • Sudden onset

  • Often follows an upper respiratory tract infection

Epidemiology

• • 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

    -Staphylococci

    -Pneumococci

    -Coliforms

  • May be associated with a piriform sinus fistula

  • Extremely rare causes include:

  • -TB

    -Actinomycoses

    -Echinococcosis

    -Aspergillosis

    -Syphilis

  • 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

Surgery

• • Thyroid abscess drained operatively

Indications

• • 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)

Medications

• • 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

References