Suppurative thyroiditis: Systematic review and clinical guidance

Abstract

Acute suppurative thyroiditis (AST) is a rare condition. The following factors are thought to make the thyroid relatively resistant to infection: the thyroid capsule, its rich blood supply and lymph drainage and its high iodine concentration. 1 The usual presentation of AST is with neck pain, fever, elevated white cell count (WCC), elevated ESR and at times hyperthyroidism, making it initially difficult to clinically distinguish from subacute thyroiditis (SAT), although patients with AST are often systemically unwell while those with SAT less so. SAT (also known as de Quervain's or granulomatous thyroiditis) is a much more common, self-limiting condition that may require treatment with anti-inflammatory drugs or glucocorticoids.Acute suppurative thyroiditis has a reported mortality of 3.7%-9% 2,3 and therefore it is crucial to make a timely diagnosis. Due to its low incidence, our knowledge of AST is based on isolated case reports, small case series, two reviews over the past 90 years (describing the literature from 1900-1980 by Berger et al and 1980-1997 by Yu et al) 2,3 and one expert opinion guideline. 4 The purpose of this paper is to report 2 unpublished cases, and to perform a systematic review of reported cases over the past 20 years of the epidemiology, clinical features, investigations, management

Clinical Analysis of Acute Suppurative Thyroiditis in 18 Children

“… 9 Similar to previous studies, in our study, we observed that AST occurs in a slightly higher percentage of females. 10 …”

“…The primary clinical manifestations of AST include neck pain, fever, dysphagia, dysphonia, and erythema. 10 Laboratory examinations may show leukocytosis and elevated ESR and CRP levels in some children without specific serum markers. 18 Thyroid function tests are usually normal.…”

“…9 Similar to previous studies, in our study, we observed that AST occurs in a slightly higher percentage of females. 10 Most children with AST have anatomical abnormalities, such as cysts and PSF. 11,12 Branchial cleft cyst anomalies are more susceptible to thyroid infections and abscess formation.…”

A Rare and Challenging Case of Neck Infection - Thyroid Abscess

“…Abscess should be aspirated and sent for culture and staining to assist in the diagnosis and choice of proper antimicrobial therapy, as well as for cytology to ensure that a malignancy has not been missed [ 11 ]. The aspirate should be stained for bacteria, fungi, and mycobacteria and cultured for aerobic and anaerobic organisms.…”

The Burden of Hormonal Disorders: A Worldwide Overview With a Particular Look in Italy

“…Among the predisposing factors, the most important is immunosuppression, followed by the presence of the pyriform sinus fistula, diabetes mellitus, and disseminated infection. Complications and sequelae include airway obstruction, dysphagia, esophageal perforation or fistula, Horner’s syndrome, an extension of the abscess resulting in mediastinitis, pericarditis, thrombophlebitis, sepsis, thyroid dysfunction associated with thyroiditis (hyper- or hypothyroidism), and death ( 32 ).…”