Clinical Analysis of Acute Suppurative Thyroiditis in 18 Children

Abstract

Objective To summarize our clinical experience with the diagnosis and treatment of children with acute suppurative thyroiditis (AST). Methods We retrospectively reviewed the clinical data of 18 children with AST treated at our hospital between January 2009 and May 2022. Results There were 8 boys and 10 girls, aged 7.8 ± 3.8 years at admission. The main clinical manifestations were fever (88.9%), neck pain (100%), and neck mass (100%). Blood and pus cultures were performed in 9 and 15 patients, respectively. All blood cultures were negative, while positive pus cultures were noted in eight cases (six Streptococcus spp ., one Staphylococcus spp ., and one Streptococcus spp . and Staphylococcus spp . mixed infection). Additionally, all patients received antibiotic treatment: three received antibiotics alone, seven received antibiotics and ultrasound (US)-guided needle aspiration, seven received antibiotics as well as surgical incision and drainage, and one received antibiotics, US-guided needle aspiration in addition to surgical incision and drainage. Consequently, the average length of hospital stay in patients who received antibiotics and US-guided needle aspiration was 9.1±2.9 days compared to 14.0±2.0 days in patients in the antibiotics alone group and 13.0 ± 2.2 days in patients in the antibiotics and surgical incision and drainage group. Follow-up was conducted in 15 of the 18 patients. Three patients relapsed, and the prognosis of the other patients was good. Conclusion AST has atypical clinical symptoms at the early stage. Regular monitoring of the thyroid gland using ultrasonography is strongly advised in unsure cases. Antibiotics combined with US-guided aspiration is a safe, effective, and minimally invasive treatment for AST in children and can reduce hospital stay. However, surgery may be necessary, particularly in the presence of complications. It is strongly recommended that patients with recurrence be examined for anatomical abnormalities and undergo radical treatment.

Acute Suppurative Thyroiditis in Childhood: An Atypical Presentation

“…If extensive disease is present, or if it is refractory to incision and drainage, hemi- or total thyroidectomy may become necessary [ 15 ]. Post-surgical care should include assessment of active hemorrhage, airway compromise due to tissue edema and seroma, and damage to tissues in the area, such as the parathyroid glands and the recurrent and superior laryngeal nerves [ 16 ]. It should also include monitoring of thyroid function, due to the manipulation of thyroid structures during surgery, with follicle disruption.…”

“…She et al [ 16 ] retrospectively reviewed the clinical data of 18 children treated between 2009 and 2022 in a tertiary hospital in China. Our patient was younger than most pediatric cases reported in the literature.…”

Case report: Fourth branchial cleft cyst: a case of acute suppurative thyroiditis

“…In this report, we describe the case of a healthy child with an anterior neck mass causing airway compression and thyroiditis, resulting from an infected fourth branchial cleft cyst that communicated with the superior left lobe of the thyroid. This association is not uncommon, according to the available literature (4)(5)(6)(7). However, due to the infrequent occurrence of these congenital malformations, they may not always be recognizable in clinical practice.…”