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

Abstract

BackgroundAbscess 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.MethodsThe 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.ResultsFive 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).ConclusionThyroid 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 suppurative thyroiditis seeded from infective endocarditis and intravenous drug use

“…However, dysphagia, dysphonia, and pharyngitis are the most common symptoms and occur in about >70 % of patients [ 2 , 3 ]. Other signs and symptoms include fever, leukocytosis, local warmth, erythema, neck pain, pharyngitis, dysphagia, or cough [ 2 , 3 , 7 ]. Other complications include extension of the abscess into neighboring structures, necrotizing mediastinitis, and perforation of the trachea or esophagus [ 1 ].…”

Acute Suppurative Thyroiditis Secondary to Tuberculosis with Superimposed Bacterial Infection: A Case Report

“…Additionally, Falhammar and collegues published six case series of adult patients with AST. 8 The causative factors were identified as iatrogenic in two patients from FNA of thyroid gland and septicaemia from prostate biopsy in the other. Blood cultures were positive in three ( Streptococcus pneumonia, Streptococcus sanguinis, Pepto streptococci ), deep tissue culture in three ( Escherichia coli, Candida, Hemophilus influenzae ) and no positive culture at all in two.…”

Firm mass in thyroid of an elderly patient: not always cancer

“…However, in our case, the material obtained from FNAC and trucut biopsy were inconclusive to rule out a thyroid malignancy due to the presence of spindle cells that resembled aggressive cancer cells. AST may include a various spectrum of clinical pictures (8) and is a potentially life-threatening endocrine disease (3). Its treatment comprises two levels of management.…”