Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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 ++Brook I: Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg 2004;62:1545. [PubMed: 15573356] Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth