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Acute suppurative thyroiditis is an uncommon disorder caused by a bacterial infection, usually presenting with normal thyroid function. It is a serious condition that requires a prompt diagnosis and treatment with antibiotics and supportive measures. A 62 years-old female presented with a painful cervical induration and odynophagia a week after a fish bone had been removed from her pharynx. She was febrile, and tachycardic and, on physical examination, a painful thyroid mass was detected. High inflammatory parameters and thyrotoxicosis were confirmed: thyroid stimulating hormone (TSH) < 0.01 mIU/L (normal range [NR] 0.27-4.2); free thyroxine (FT4) 3.86 ng/dL (NR 0.9-1.7) and anti-TSH receptor antibodies (TRABs) 5.3 U/L (NR < 1.5). Thyroid scintigraphy showed a diffuse uptake of the thyroid parenchyma suggesting Graves disease. Cervical ultrasonography revealed an abscess of the left thyroid lobe of 36 × 36 mm and fine needle aspiration biopsy (FNAB) with partial drainage was performed. Staphylococcus aureus and Streptococcus viridans were isolated, and directed antibiotic therapy was started. Clinical improvement was observed as well as a decrease of inflammatory parameters and the patient was discharged after 9 days of hospitalization. Eighteen days after discharge, thiamazole was initiated due to persistent thyrotoxicosis. Complete resolution of the abscess was documented within 6 months and the patient became euthyroid under thiamazole one year after initial presentation. To our knowledge, this is the third case reporting an association between acute thyroiditis and Graves disease. Furthermore, this is the first case detailing the simultaneous diagnosis of acute suppurative thyroiditis caused by a foreign body and Graves disease.

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SUMMARY Acute suppurative thyroiditis (AST) is a rare but potentially life-threatening thyroid disease with a high mortality if left untreated. Thus, differentiation from other thyroid disorders is highly important in clinical practice. A 22-year-old male patient was admitted to a tertiary care hospital with cervical pain, palpitations, thyrotoxicosis, and an inhomogeneously enlarged right thyroid lobe. In view of the clinical findings, subacute thyroiditis (SAT) was suspected and treatment with glucocorticoids was started. After initial amelioration, the patient developed cervical erythema, fever, and recurrent pain. A CT scan showed extensive phlegmonous inflammation and abscess formation, suggestive of AST. We started immediate empiric antibiotic therapy and performed surgical drainage of the abscess formations. Subsequently, the patient developed hypoxic respiratory failure, leading to ICU admission and intermittent need for non-invasive ventilation. Blood and abscess cultures were positive for Streptococcus anginosus. If left untreated, AST represents a potentially life-threatening disease. Thus, in clinically doubtful cases, liberal further assessment by means of cervical CT scans or fine needle aspiration biopsy are strongly advised.

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Acute suppurative thyroiditis (AST) is a rare but potentially life-threatening thyroid disease with a high mortality if left untreated. Thus, differentiation from other thyroid disorders is highly important in clinical practice. A 22-year-old male patient was admitted to a tertiary care hospital with cervical pain, palpitations, thyrotoxicosis, and an inhomogeneously enlarged right thyroid lobe. In view of the clinical findings, subacute thyroiditis (SAT) was suspected and treatment with glucocorticoids was started. After initial amelioration, the patient developed cervical erythema, fever, and recurrent pain. A CT scan showed extensive phlegmonous inflammation and abscess formation, suggestive of AST. We started immediate empiric antibiotic therapy and performed surgical drainage of the abscess formations. Subsequently, the patient developed hypoxic respiratory failure, leading to ICU admission and intermittent need for non-invasive ventilation. Blood and abscess cultures were positive for Streptococcus anginosus. If left untreated, AST represents a potentially life-threatening disease. Thus, in clinically doubtful cases, liberal further assessment by means of cervical CT scans or fine needle aspiration biopsy are strongly advised.

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Acute suppurative thyroiditis is an infectious disease, uncommon in children, caused by various microorganisms, being bacteria the most frequently involved. The typical presentation includes the appearance of a tumor in combination with signs of swelling in the anterior aspect of the neck, which is painful on palpation and is associated with warmth and erythema. It usually moves with swallowing and the patient can suffer fever, dysphagia or dhysfonia. In children, congenital anomalies can lead to the gland's infection, and the surgical excision of them is important to prevent recurrency. A quick diagnosis, based on clinical manifestations and imaging studies, is necessary to install an adequate antibiotic treatment. We present the case of a 3-year-old patient, who was previously healthy, with a painful left cervical tumor associated with fever. During the hospitalization, we reached the diagnosis of acute suppurative thyroiditis caused by an underlying pyriform sinus fistula.

La tiroiditis aguda supurada es una entidad poco frecuente en pediatría; de origen infeccioso, cuya etiología más frecuente es bacteriana. Su presentación típica en niños es la aparición de una tumoración en la cara anterior del cuello, con signos de flogosis, dolorosa, caliente y eritematosa, que excursiona con la deglución, y puede o no estar acompañada de fiebre, disfagia o disfonía. En niños, las anomalías congénitas, principalmente la fístula del seno piriforme, predisponen a la infección de la glándula, por lo que es importante la resolución quirúrgica del defecto anatómico para prevenir las recurrencias. El diagnóstico rápido, basado en la clínica y los estudios por imágenes, es importante para comenzar en forma temprana con un tratamiento antibiótico adecuado. Se presenta una paciente de 3 años, previamente sana, con tumoración cervical izquierda dolorosa y asociada a fiebre. Durante la internación, se arribó al diagnóstico de tiroiditis aguda supurada secundaria a fístula de seno piriforme.

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La tiroiditis aguda supurada es una entidad poco frecuente en pediatría; de origen infeccioso, cuya etiología más frecuente es bacteriana. Su presentación típica en niños es la aparición de una tumoración en la cara anterior del cuello, con signos de flogosis, dolorosa, caliente y eritematosa, que excursiona con la deglución, y puede o no estar acompañada de fiebre, disfagia o disfonía. En niños, las anomalías congénitas, principalmente la fístula del seno piriforme, predisponen a la infección de la glándula, por lo que es importante la resolución quirúrgica del defecto anatómico para prevenir las recurrencias. El diagnóstico rápido, basado en la clínica y los estudios por imágenes, es importante para comenzar en forma temprana con un tratamiento antibiótico adecuado.Se presenta una paciente de 3 años, previamente sana, con tumoración cervical izquierda dolorosa y asociada a fiebre. Durante la internación, se arribó al diagnóstico de tiroiditis aguda supurada secundaria a fístula de seno piriforme.

Acute suppurative thyroiditis is an infectious disease, uncommon in children, caused by various microorganisms, being bacteria the most frequently involved. The typical presentation includes the appearance of a tumor in combination with signs of swelling in the anterior aspect of the neck, which is painful on palpation and is associated with warmth and erythema. It usually moves with swallowing and the patient can suffer fever, dysphagia or dhysfonia. In children, congenital anomalies can lead to the gland's infection, and the surgical excision of them is important to prevent recurrency. A quick diagnosis, based on clinical manifestations and imaging studies, is necessary to install an adequate antibiotic treatment. We present the case of a 3-year-old patient, who was previously healthy, with a painful left cervical tumor associated with fever. During the hospitalization, we reached the diagnosis of acute suppurative thyroiditis caused by an underlying pyriform sinus fistula

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Objective There is currently no consensus regarding the optimal management of acute suppurative thyroiditis (AST) secondary to pyriform sinus fistula (PSF). To investigate the benefits and adverse events of aspiration with or without lavage for the treatment of AST secondary to PSF. Subjects and methods This was a retrospective analysis of consecutive patients with AST secondary to PSF who were admitted at the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University between August 2012 and December 2018. Clinical information, procedural data, and imaging data were analyzed. Results Seven patients (five women; mean age, 16.9 ± 6.3 years; range, 8-26 years) were included. The patients most presented with anterior neck pain and swelling (n = 7), fever (n = 7), or odynophagia (n = 5). Six cases of AST occurred on the left side of the thyroid and 1 on the right. All patients had thyroid abscess. AST was diagnosed by ultrasound-guided needle aspiration cytology in all cases. PSF was diagnosed during the inflammatory stage in five patients and during the quiescent stage in two. All patients were treated with empiric antibiotics. Needle aspiration without lavage was performed in three cases. Needle aspiration with lavage was performed in four cases. Repeat aspiration was performed in three cases. All patients recovered completely, with no procedure-related complications. During 18.3 ± 7.8 months of follow-up, AST recurred in one case. Excision of the PSF was performed in another case. Conclusion Ultrasound-guided aspiration with or without lavage had a good treatment effect and without adverse events for the management of AST secondary to PSF.

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ABSTRACT Objective There is currently no consensus regarding the optimal management of acute suppurative thyroiditis (AST) secondary to pyriform sinus fistula (PSF). To investigate the benefits and adverse events of aspiration with or without lavage for the treatment of AST secondary to PSF. Subjects and methods This was a retrospective analysis of consecutive patients with AST secondary to PSF who were admitted at the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University between August 2012 and December 2018. Clinical information, procedural data, and imaging data were analyzed. Results Seven patients (five women; mean age, 16.9 ± 6.3 years; range, 8-26 years) were included. The patients most presented with anterior neck pain and swelling (n = 7), fever (n = 7), or odynophagia (n = 5). Six cases of AST occurred on the left side of the thyroid and 1 on the right. All patients had thyroid abscess. AST was diagnosed by ultrasound-guided needle aspiration cytology in all cases. PSF was diagnosed during the inflammatory stage in five patients and during the quiescent stage in two. All patients were treated with empiric antibiotics. Needle aspiration without lavage was performed in three cases. Needle aspiration with lavage was performed in four cases. Repeat aspiration was performed in three cases. All patients recovered completely, with no procedure-related complications. During 18.3 ± 7.8 months of follow-up, AST recurred in one case. Excision of the PSF was performed in another case. Conclusion Ultrasound-guided aspiration with or without lavage had a good treatment effect and without adverse events for the management of AST secondary to PSF.

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Acute suppurative thyroiditis is a very rare and life-threatening endocrine emergency. Thyrotoxicosis is a rare condition accompanying acute suppurative thyroiditis. While the majority of the cases in the literature are caused by different reasons, spontaneous development is very rare. We present a patient with acute suppurative thyroiditis who presented to our clinic with thyrotoxic findings, and we compared the case to the literature. A 31-year-old male patient was admitted to our clinic with a complaint of progressive neck pain, swelling and redness on midline neck, fever, and palpitations. On physical examination, swelling, redness and tenderness were detected on the neck region that was consistent with the thyroid location. He presented with tremor on the hands, tachycardia and agitation. Thyroid function tests were compatible with thyrotoxicosis, but there were findings supporting the presence of infection in biochemistry tests. On his radiological evaluations, a heterogeneous lesion divided with small septs was observed, with consolidation areas in the left thyroid lobe. In fine needle aspiration biopsy, 2mL of purulent fluid could be aspirated due to the presence of small, separated consolidation areas. He initiated on antibiotic therapy, propranolol, steroid and symptomatic treatment. Eikenella corrodens was detected on the culture antibiogram. Antibiotic therapy was continued for 14 days due to less symptoms and better biochemical values. After treatment, the patient had normal thyroid function, had relief of fever and redness of the neck, and was followed-up. It should be kept in mind that acute suppurative thyroiditis may develop spontaneously with the findings of thyrotoxicosis, with no risk factors.

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ABSTRACT Acute suppurative thyroiditis is a very rare and life-threatening endocrine emergency. Thyrotoxicosis is a rare condition accompanying acute suppurative thyroiditis. While the majority of the cases in the literature are caused by different reasons, spontaneous development is very rare. We present a patient with acute suppurative thyroiditis who presented to our clinic with thyrotoxic findings, and we compared the case to the literature. A 31-year-old male patient was admitted to our clinic with a complaint of progressive neck pain, swelling and redness on midline neck, fever, and palpitations. On physical examination, swelling, redness and tenderness were detected on the neck region that was consistent with the thyroid location. He presented with tremor on the hands, tachycardia and agitation. Thyroid function tests were compatible with thyrotoxicosis, but there were findings supporting the presence of infection in biochemistry tests. On his radiological evaluations, a heterogeneous lesion divided with small septs was observed, with consolidation areas in the left thyroid lobe. In fine needle aspiration biopsy, 2mL of purulent fluid could be aspirated due to the presence of small, separated consolidation areas. He initiated on antibiotic therapy, propranolol, steroid and symptomatic treatment. Eikenella corrodens was detected on the culture antibiogram. Antibiotic therapy was continued for 14 days due to less symptoms and better biochemical values. After treatment, the patient had normal thyroid function, had relief of fever and redness of the neck, and was followed-up. It should be kept in mind that acute suppurative thyroiditis may develop spontaneously with the findings of thyrotoxicosis, with no risk factors.

RESUMO A tireoidite supurativa aguda é uma emergência endócrina muito rara e com risco de vida. A tireotoxicose é uma doença rara, que acompanha a tireoidite supurativa aguda. A maioria dos casos descritos na literatura tem diferentes causas, mas o desenvolvimento espontâneo é muito raro. Relatamos o caso de um paciente com tireoidite supurativa aguda, que veio a nossa clínica apresentando achados tireotóxicos, e o comparamos com a literatura. Trata-se de paciente do sexo masculino, 31 anos, que foi internado em nossa clínica com queixa de dor progressiva, edema e vermelhidão na linha média do pescoço, febre e palpitações. Ao exame físico, foram observados edema, vermelhidão e sensibilidade à dor na região do pescoço, consistente com a localização da tireoide. Apresentava tremor de mãos, taquicardia e agitação. Embora os exames de função tireoidiana fossem compatíveis com tireotoxicose, houve achados que sustentavam a presença de infecção nos exames bioquímicos. Nas avaliações radiológicas, observou-se lesão heterogênea dividida por pequenos septos, com áreas de consolidação no lobo tireoidiano esquerdo. Na biópsia por aspiração por agulha fina, foi possível aspirar apenas 2mL de líquido purulento, devido à presença de pequenas áreas de consolidação separadas umas das outras. Iniciaram-se antibioticoterapia, administração de propranolol e esteroides, além de tratamento sintomático. Eikenella corrodens cresceu na cultura do antibiograma. A antibioticoterapia foi estendida por 14 dias devido à melhora nos sintomas e dos valores bioquímicos. Após o tratamento, o paciente se apresentava eutireoideo, com melhora na febre e na vermelhidão no pescoço, sendo então acompanhado. Deve-se ter em mente que a tireoidite supurativa aguda pode se desenvolver espontaneamente com achados de tireotoxicose, sem nenhum fator de risco.

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El término tiroiditis comprende un grupo de enfermedades de la glándula tiroides caracterizado por la presencia de inflamación, abarcando entidades autoinmunes y no-autoinmunes. Pueden manifestarse como enfermedades agudas con dolor tiroideo severo (tiroiditis subaguda y tiroiditis infecciosas), y condiciones en las cuales la inflamación no es clínicamente evidente, cursando sin dolor y presentando disfunción tiroidea y/o bocio (tiroiditis inducida por fármacos y tiroiditis de Riedel). El objetivo de esta revisión es aportar un enfoque actualizado sobre las tiroiditis no-autoinmunes cubriendo sus aspectos clínicos, diagnósticos y terapéuticos.

The term thyroiditis comprises a group of thyroid diseases characterized by the presence of inflammation, including autoimmune and non-autoimmune entities. It may manifest as an acute illness with severe thyroid pain (subacute thyroiditis and infectious thyroiditis), and conditions in which the inflammation is not clinically evident evolving without pain and presenting primarily thyroid dysfunction and/or goiter (drug-induced thyroiditis and Riedel thyroiditis). The aim of this review is to provide an updated approach on non-autoimmune thyroiditis and its clinical, diagnostic and therapeutic aspects.

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