The tender neck: thyroiditis or thyroid abscess?

Abstract

Following apparent subacute thyroiditis, a 16-year-old girl developed a left thyroid abscess thought to be secondary to steroids and haematogenous spread from a pilonidal abscess. The thyroid suppuration became recurrent and required partial thyroidectomy. Further left-sided abscess formation in the neck prompted a barium swallow which revealed the source of infection to be a sinus tract arising from the left piriform fossa. The patent fourth branchial sinus tract was later excised. All patients with a tender thyroid should have ultrasound-guided fine needle aspiration to establish the diagnosis. If suppuration is confirmed, a barium swallow is advised to exclude a sinus tract from the piriform fossa.

Transient hyperthyroidism due to acute suppurative thyroiditis in an adolescent female

“…The thyroid gland is remarkably resistant to infection because of its fi brous encapsulation, high iodine level, and large lymphatic supply (3,4) . In the immune-competent child, an anatomic defect such as a left piriform sinus fi stula (as was found in our patient) or a thyroglossal duct remnant or local trauma, is a common possible predisposing factor for the development of thyroid infection (3,5) .…”

A Case of Acute Suppurative Thyroiditis with Thyrotoxicosis in an Elderly Patient

“…Subacute thyroiditis involves the entire thyroid and thyrotoxicosis occurs due to the temporary discharge of thyroid hormone caused by the destruction of about 50% of the thyroid tissue in the early stage of disease. Meanwhile, AST is rarely accompanied by thyrotoxicosis, so that it is an important finding for differentiation from subacute thyroiditis [5,6,13]. As in this case, AST accompanied by thyrotoxicosis is more difficult to differentiate from subacute thyroiditis, resulting in cases with delayed diagnosis due to misdiagnosis as subacute thyroiditis [1,5].…”

Salmonella thyroid abscess in a pre-existing multinodular goitre: rare clinical entity with review of literature

“…10 Patients with suppurative thyroiditis have leukocytosis, an elevated ESR and thyroid hormone profile which is normal or mildly hyperthyroid. 10,11 USG is helpful in identifying the underlying abscess and its extent. It can guide the FNAC needle into the cavity for aspiration.…”