Acute suppurative thyroiditis progressing to a thyroid abscess; a case report with review of literature

Baba, Hiwa O.; Salih, Abdulwahid M.; Hammood, Zuhair D.; Rashid, Rezheen J.; Abdullah, Ismael Y.; Kakamad, Fahmi H.; Abdulla, Berwn A.

doi:10.1016/j.ijso.2021.100433

Cited by 3 publications

(7 citation statements)

References 26 publications

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“…As demonstrated by our patient, most individuals are euthyroid at admission [ 8 , 9 , 12 ]. Nevertheless, thyrotoxicosis caused by follicular disruption and hypothyroidism may be identified in 12% and 17% of cases, respectively [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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Acute Suppurative Thyroiditis in Childhood: An Atypical Presentation

Câmara,

Andrade,

Forno

et al. 2024

Cureus

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Neck stiffness is a common clinical sign in children presenting to the emergency department that may indicate a wide variety of diagnoses. Acute suppurative thyroiditis (AST) is an infection of the thyroid gland caused by a bacterium, virus, or, less commonly, fungus. It presents as an acute or subacute development of an anterior cervical mass, with associated inflammatory signs. The pressure upon neck muscles may be reflected as a limitation of cervical mobility. AST is often preceded by an upper respiratory tract infection, and pyriform sinus fistula is the most common predisposing factor. It is particularly uncommon in the pediatric age, with limited cases reported in the literature. Therefore, a heightened suspicion is required for proper diagnosis and timely intervention, due to its high mortality. Prompt treatment with broad-spectrum parenteral antibiotic therapy and drainage is mandatory to prevent the numerous complications associated, namely, mediastinitis and sepsis. We report the case of a two-year-old female child admitted with a two-week history of intermittent high-grade fever and sore throat, followed by prostration and limitation in neck movement on admission. Examination revealed neck stiffness with positive Kernig and Brudzinski signs. The laboratory tests showed elevated inflammatory parameters. Cranial computed tomography (CT) scan and lumbar puncture were normal. On day 2 after admission, an anterior cervical mass with slight signs of fluctuation was detected. Ultrasound was compatible with a hemorrhagic/overinfected thyroid nodule, and the patient was started on broad-spectrum antibiotics. Due to clinical worsening, a cervical CT scan was performed, which documented a thyroid abscess with extension into the retropharyngeal space. She underwent surgical drainage, and Streptococcus anginosus and mixed anaerobes were isolated, sensitive to ongoing antibiotherapy. On multidisciplinary follow-up, an esophageal barium study, laryngoscopy, and cervical magnetic resonance imaging (MRI) were performed, revealing no anatomical defects. AST is a rare disease in children, but potentially fatal, so its early recognition and treatment are essential. We aim to draw attention to this disease and its differential diagnosis to reduce the associated morbimortality.

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Section: Discussionmentioning

confidence: 99%

“…It is crucial to make a timely diagnosis due to its mortality of 12% or higher. Most cases occur under the age of 40 years, with a slight female predominance [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Acute Suppurative Thyroiditis in Childhood: An Atypical Presentation

Câmara,

Andrade,

Forno

et al. 2024

Cureus

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“…AST is a rare life-threatening endocrine emergency of the thyroid gland. Approximately 92% of those affected are under the age of 49 years, with a slight female predominance [ 6 , 16 ]. In this case, age was older than the usual age which was 49 years.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 92% of those affected are under the age of 49 years, with a slight female predominance [ 5 , 6 , 16 ]. Progression to abscess formation is even rarer since the thyroid gland’s structural and physiological features protect it against infection.…”

Section: Introductionmentioning

confidence: 99%

Thyrotoxicosis as a rare presentation in acute suppurative thyroiditis: a case report

Seyedjavadeyn,

Miratashi Yazdi,

Samimiat

et al. 2023

J Med Case Reports

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Background Acute suppurative thyroiditis is a rare and potentially life-threatening disease. A few cases of acute suppurative thyroiditis associated with thyrotoxicosis have been reported in adults. We report a case of acute suppurative thyroiditis that was associated with thyrotoxicosis. Case presentation We report the case of a 49-year-old Iranian female presented with a painful neck swelling for a week. Computed tomography showed a well-defined gas-filled collection in the left thyroid lobe with an enhancing margin. The patient underwent two-phase surgery, first left thyroid abscess drainage and then total thyroidectomy. The result of histopathology examination was multinodular goiter with abscess formation without malignancy. Conclusion Abscess formation and thyrotoxicosis is a very rare condition that occurs at the same time in acute suppurative thyroiditis. Despite antibiotic therapy being the first line of treatment, surgery is also required when antibiotic therapy fails.

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“…It accounts for 0.1-0.7% of the pathologies affecting thyroid gland. 1 Acute suppurative thyroiditis usually does not occur without pre-existing infections due to factors such as the rich blood supply, lymphatic drainage, high iodine content, the ability to synthesize peroxide and other oxidizing radical compounds and the presence of fascia that functions as a tight covering encapsulating the thyroid gland, all of which makes the gland resistant to infection. 2 It is known to occur in concurrence with pre-existing pathologies of the thyroid gland such as hyperthyroidism, malignancies of the thyroid and Hashimoto's thyroiditis.…”

Section: Introductionmentioning

confidence: 99%

The conundrum of acute onset midline neck swellings: a unique case report of a thyroid abscess

Shetti,

Vasudevan,

Amin

2023

Int J Otorhinolaryngol Head Neck Surg

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The conditions of the thyroid gland are the most common causes for midline neck swellings and present with a spectrum of clinical features and differential diagnosis, some more fatal than the others. One such rare yet worrisome condition is suppurative thyroiditis progressing to an abscess. A 17 year old male presented with an acute neck swelling with fever, pain, and hoarseness of voice. Investigations revealed leucocytosis with normal thyroid hormone levels. Contrast enhanced CT scan of the neck showed presence of an abscess of the thyroid gland with left sided tracheal shift. Incision and drainage with antibiotic support was done leading to an uneventful recovery. The thyroid gland by virtue of its capsule, rich blood supply, and high iodine content is resistant to infection. Thyroid abscess is a rare condition with high morbidity and mortality. This condition should be a differential diagnosis in cases of acute onset midline swellings. Immediate surgical drainage of the collection with antibiotic support is the gold standard treatment of this condition.

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Acute suppurative thyroiditis progressing to a thyroid abscess; a case report with review of literature

Cited by 3 publications

References 26 publications

Acute Suppurative Thyroiditis in Childhood: An Atypical Presentation

Acute Suppurative Thyroiditis in Childhood: An Atypical Presentation

Thyrotoxicosis as a rare presentation in acute suppurative thyroiditis: a case report

The conundrum of acute onset midline neck swellings: a unique case report of a thyroid abscess

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