Acute suppurative thyroiditis with thyroid abscess in adults: clinical presentation, treatment and outcomes

Abstract

Background Abscess in the thyroid gland is a rare but severe infectious disease. The condition can have anatomic or iatrogenic underlying causes. If untreated it could be fatal. Pathogens vary considerably. Treatment is intravenous antibiotics, drainage, and sometimes surgery. Methods The electronic medical records of all adult patients with acute thyroiditis 2003–2017 treated at the Karolinska University Hospital (catchment area 2 million) in Sweden were systematically reviewed. Results Five patients were found in the catchment area. One patient from another region but known to us was also included. Thus, six patients (aged 28-73 years) were included in the study. Median length of hospital stay was 7.5 days (4-79 days). All were treated with antibiotics (intravenous n=5, oral n=1). Total antibiotic treatment duration was 13.5 days (10-41 days). Blood cultures were positive in three (streptococcus pneumonia, streptococci sanguineous, pepto streptococci), deep tissue culture in three (escherichia coli, candida, hemophilic influenza) and no positive culture at all in two. Drainage was used in three patients. All patients recovered without recurrences. Surgery was performed twice in the acute phase in one. There was no recurrence during 7 years (3-12) of follow-up, but one patient died after three years (severe heart failure and pneumonia). Conclusion Thyroid abscess in adults is extremely rare nowadays in the developed world. With prompt antibiotic therapy, drainage and in some cases thyroidectomy the prognosis seems favourable.

Acute Bacterial Suppurative Thyroiditis following Fine Needle Aspiration: A Case Report and Review of the Literature

“…In earlier reviews, underlying thyroid abnormalities and immunocompromised status were two important risk factors for the development of acute suppurative thyroiditis [3,4]. However, in a recent case series, spontaneous acute bacterial suppurative thyroiditis has been increasingly reported in immunocompetent patients without underlying structural abnormality such as pyriform sinus fistula [5]. Also, these patients had a more favorable prognosis than the earlier case series.…”

Subakute Thyreoiditis und akute suppurative Thyreoiditis

“…Auch die Messung von Thyreoglobulin kann zwar Hinweise für die Schilddrüse als Ort der Inflammation geben, der Thyreoglobulinspiegel im Serum ist aber auch z. B. bei anderen Erkrankungen mit Beschädigung der Schilddrüsenfollikel erhöht [38]. Wie bei allen Formen der destruktiven Thyreoiditis kann es auch bei der AST zum Auftreten einer Thyreotoxikose kommen, diese tritt jedoch deutlich seltener auf als bei der SAT (z.…”

Thyroid Abscess Associated With Pyriform Sinus Fistula

“…It usually occurs in patients with trauma, invasive procedures, immunosuppression, preexisting thyroid disease, or anatomical anomaly (such as pyriform sinus fistula). [1][2][3] For this reason, a search for anatomical anomaly is required after controlling the acute infection in patients without the apparent causes. 1,2 Pyriform sinus fistula is a rare congenital branchial cleft anomaly, more frequent in the left side, and associated with recurrent neck or thyroid infection.…”

“…[1][2][3] For this reason, a search for anatomical anomaly is required after controlling the acute infection in patients without the apparent causes. 1,2 Pyriform sinus fistula is a rare congenital branchial cleft anomaly, more frequent in the left side, and associated with recurrent neck or thyroid infection. [1][2][3] Surgical removal or chemocauterization of the fistula is recommended to prevent recurrent infection.…”

“…1,2 Pyriform sinus fistula is a rare congenital branchial cleft anomaly, more frequent in the left side, and associated with recurrent neck or thyroid infection. [1][2][3] Surgical removal or chemocauterization of the fistula is recommended to prevent recurrent infection.…”