Sonographic features of acute suppurative thyroiditis

Abstract

The sonographic diagnosis of diffuse thyroid disease has received scant attention in the ultrasound literature. Several authors have described the ultrasound appearance of various diffuse thyroid diseases, such as subacute thyroiditis,' Hashimoto's t h y r~i d i t i s ,~,~ and acute thyroiditi~.~ Our case report describes the sonographic features of acute suppurative thyroiditis. Correlative radionuclide images are included. CASE REPORTThe patient was a 28-yr-old woman who had recently arrived in this country from Jamaica. She was well until 5 yr prior to admission to our hospital, when she was diagnosed as having systemic lupus erythematosus (SLE) after presenting with arthralgia and arthritis. Renal biopsy done at that time revealed basement membrane thickening. She has subsequently suffered from various complications of SLE, as well as from steroid-induced cataracts, hypertension with one episode of pulmonary edema, nephrotic syndrome, and herpes zoster. Medications have included prednisone (up to 40 mg/day), Lasix, digoxin, and Inderal.On present admission, the patient complained of a sore throat with temperatures of up to 103°F. Laboratory tests at that time demonstrated an elevated white blood cell count with a left shift, an erythrocyte sedimentation rate of 103, and a urinalysis revealing red blood cell casts. An infection-induced lupus flare was deduced, for which she was treated with high-dose prednisone. During her hospital stay, she developed rapid swelling of the neck, with the right side greater than 222the left. Nuclear medicine 99mT~ pertechnetate thyroid scan revealed an ill-defined 3 X 3-cm cold nodule in the right lobe (Fig. 1). Ultrasound examination of the thyroid revealed a diffusely enlarged, somewhat irregular gland with decreased echogenicity, but no focal abnormality was demonstrated (Fig. 2). Triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) were normal 5 days following plasmapheresis treatment for SLE and a diagnosis of viral thyroiditis was made, which was treated successfully with salicylates. One week after discharge, the patient returned with an acute exacerbation of neck swelling associated with tenderness and an elevated temperature. Repeat nuclear medicine scans and an ultrasound examination of the thyroid were performed (Figs. 3, 4).The patient was taken to the operating room, where 300 cc of purulent material was aspirated from the swelling in the neck. Cultures revealed alpha streptococcus, sensitive to penicillin, and the patient was treated with 6 million units/day. The patient responded well and was subsequently discharged to complete the antibiotic therapy. DISCUSSIONThyroid sonography has been found to be a reliable tool for evaluating the hypo-or nonfunctioning thyroid nodule and for differentiating cystic and solid masses of the thyroid gland.2,4 However, the role of ultrasound in diffuse thyroid disease is less well appreciated. The common entities of subacute thyroiditis and Hashimoto's thyroiditis are usually easily differentiated and man...

Atypical presentation of subacute thyroiditis.

“…Both the initial ultrasound and the radioisotope scans were consistent with the diagnosis, as described by Clair et al 6 Two features, however, could retrospectively suggest that this was not the case: the lack of abscess formation and the impaired thyroid function tests. The migration of the inflammatory process to the opposite lobe is also characteristic of subacute thyroiditis.1 2 The increased antibody titre against adenovirus (from less than 1:10 to 1:120) suggests that adenovirus infection was associated with the subacute thyroiditis in this case.…”

Fine Needle Aspiration Cytology in the Management of Acute Suppurative Thyroiditis

“…In older patients, anaplastic carcinoma has the same ENT Journal• June 1994 feature as AST, includ ing go iter with signs ofloca l inflamma tion , and FNAC is more helpful than sonographic examination for the diagnosis of such cases. 15 In one of the patient s both were coexis ting . As in adolesce nce, subac ute thyroiditis and AST sha re co mmo n clinica l features " and different iation is possibl e by FN AC of thyroid gland which would reveal pus in the latter.…”

Cervical Cellulitis With Thyroid Starting Point.

“…CT scan can be a useful imaging modality for identifying the location of abscess but it is not essential and is only reserved for unusual occasions (16).…”