No Abstract available.
Abscess* ; Thyroid Gland* ; Thyroiditis, Autoimmune ; Thyroiditis, Suppurative

Acute suppurative thyroiditis is a rare and potentially fatal condition. We present a case of an 18-year-old Malay female who presented with one-week history of painful right sided neck swelling, fever and odynophagia. Neck CT confirms ruptured multiloculated abscess with posterosuperior extension into prevertebral space. Pus and tissue cultured Streptococcus anginosus and Eikenella corrodens with positive TB PCR. She responded well to ampicillin/sulbactam and anti-tuberculosis treatment with no evidence of residual collection from ultrasound.
Thyroiditis, Suppurative

Acute suppurative thyroiditis (AST) is a rare condition, as the thyroid gland is relatively resistant to infection. Thyroid function tests are usually normal in AST. A few cases of AST associated with thyrotoxicosis have been reported in adults. We report a case of AST that was associated with thyrotoxicosis in a 70-year-old woman. We diagnosed AST with thyroid ultrasonography and fine needle aspiration of pus. The patient improved after surgical intervention and had no anatomical abnormality. Fine needle aspiration is the best method for the difficult task of differentiating malignancy and subacute thyroiditis from AST with thyrotoxicosis. Earlier diagnosis and proper treatment for AST might improve the outcome.
Adult ; Aged ; Biopsy, Fine-Needle ; Female ; Humans ; Suppuration ; Thyroid Function Tests ; Thyroid Gland ; Thyroiditis, Subacute ; Thyroiditis, Suppurative ; Thyrotoxicosis

This is the first case report about acute suppurative thyroiditis with thyrotoxicosis and pyriform sinus in Korea. A female patient, who was previously healthy, visited our hospital for the treatment of common cold symptoms and neck pain which developed 2 weeks before the visit. The condition of the patient did not improve through the use of antipyretics and even worsened. The patient was admitted to the hospital and was diagnosed with acute suppurative thyroiditis. The culture result of the drained fluid revealed group D Streptococcus. The patients condition was improved after using antibiotics and drainage. After recovery from acute thyroiditis, esophagography was performed and the pyriform sinus was found to be obliterated by chemical cauterization. It is very important yet difficult to differentiate acute thyroiditis with thyrotoxicosis from subacute thyroiditis. In this study, we discussed the differential diagnosis between acute thyroiditis and subacute thyroiditis with a review of literature.
Anti-Bacterial Agents ; Antipyretics ; Cautery ; Common Cold ; Diagnosis, Differential ; Drainage ; Female ; Fistula* ; Humans ; Korea ; Neck Pain ; Pyriform Sinus* ; Streptococcus ; Thyroid Gland ; Thyroiditis ; Thyroiditis, Subacute ; Thyroiditis, Suppurative* ; Thyrotoxicosis*

OBJECTIVE: To report the clinical characteristics and outcomes of subacute thyroiditis (SAT) patients at the Theptarin Hospital Thyroid Clinic. Methodology. A retrospective review of medical records of SAT patients in the Theptarin Hospital from January 2007 to December 2013 was conducted. Clinical characteristics, laboratory findings, modes of treatment and complications were recorded.

RESULTS: From January 2007 to December 2013, SAT was diagnosed in 149 patients, with the occurrence of SAT peaking in October and November. Of 115 patients who had complete follow-up data, mean age was 43.8±10.8 years, 88.7% were women, and SAT was preceded by an upper respiratory tract infection in 68.7%. Oral prednisolone was given in 83 cases (72.2%) at a median starting dose of 30 mg/day and was continued for a median duration of 49 days. Recurrence of SAT during the tapering period of oral prednisolone was observed in 12% of patients, resulting in reinitiation of steroid in 13% of patients for late recurrence. Transient and permanent hypothyroidism developed in 6.1% and 8.7% of patients respectively.

CONCLUSIONS: SAT in Thai patients showed seasonal clustering during October and November. Recurrences of SAT were common in the course of steroid treatment. SAT patients require careful follow-up during steroid treatment and long-term surveillance for thyroid dysfunction.
Thyroiditis, Subacute

BACKGROUND AND OBJECTIVES: In the past, subacute thyroiditis causing thyrotoxicosis included both painful and painless subgroup, but it is representative for the painful subacute thyroiditis these days. So we evaluated the clinical and laboratory characteristics of subacute thyroiditis and compared with the painless (silent) thyroiditis, and identified predictive factors of permanent hypothyroidism and recurrence. MATERIALS AND METHODS: This was a retrospective case series study analyzing clinical data of 221 consecutive patients diagnosed between 2009 and 2015. Medical records were reviewed for diagnostic route, age distribution, laboratory data, clinical course and long-term follow up outcome. RESULTS: The mean age was 48 years; female v/s male ratio 3.4:1. Median disease duration was 110 days; mean peak free T4 level was 2.9 ng/dL. 56.7% of painless thyroiditis patients were diagnosed on health checkup or routine thyroid function test with symptoms not typically associated with thyrotoxicosis. Permanent hypothyroidism was not uncommon (11/221; 5.0%). Higher peak thyroid-stimulating hormone (TSH) was associated with permanent hypothyroidism in painless thyroiditis. Lower peak TSH was associated with recurrence rate in both subacute and painless thyroiditis. In painless thyroiditis, short duration of thyrotoxicosis phase was also associated with recurrence rate. CONCLUSION: Considerable numbers of painless thyroiditis without symptoms were diagnosed on health checkup. Higher peak TSH was associated with permanent hypothyroidism in painless thyroiditis. Recurrence rate was related with lower peak TSH in both groups.
Age Distribution ; Female ; Follow-Up Studies ; Humans ; Hypothyroidism ; Male ; Medical Records ; Postpartum Thyroiditis ; Recurrence ; Retrospective Studies ; Thyroid Function Tests ; Thyroid Gland* ; Thyroiditis* ; Thyroiditis, Subacute* ; Thyrotoxicosis ; Thyrotropin

BACKGROUND AND OBJECTIVES: In the past, subacute thyroiditis causing thyrotoxicosis included both painful and painless subgroup, but it is representative for the painful subacute thyroiditis these days. So we evaluated the clinical and laboratory characteristics of subacute thyroiditis and compared with the painless (silent) thyroiditis, and identified predictive factors of permanent hypothyroidism and recurrence. MATERIALS AND METHODS: This was a retrospective case series study analyzing clinical data of 221 consecutive patients diagnosed between 2009 and 2015. Medical records were reviewed for diagnostic route, age distribution, laboratory data, clinical course and long-term follow up outcome. RESULTS: The mean age was 48 years; female v/s male ratio 3.4:1. Median disease duration was 110 days; mean peak free T4 level was 2.9 ng/dL. 56.7% of painless thyroiditis patients were diagnosed on health checkup or routine thyroid function test with symptoms not typically associated with thyrotoxicosis. Permanent hypothyroidism was not uncommon (11/221; 5.0%). Higher peak thyroid-stimulating hormone (TSH) was associated with permanent hypothyroidism in painless thyroiditis. Lower peak TSH was associated with recurrence rate in both subacute and painless thyroiditis. In painless thyroiditis, short duration of thyrotoxicosis phase was also associated with recurrence rate. CONCLUSION: Considerable numbers of painless thyroiditis without symptoms were diagnosed on health checkup. Higher peak TSH was associated with permanent hypothyroidism in painless thyroiditis. Recurrence rate was related with lower peak TSH in both groups.
Age Distribution ; Female ; Follow-Up Studies ; Humans ; Hypothyroidism ; Male ; Medical Records ; Postpartum Thyroiditis ; Recurrence ; Retrospective Studies ; Thyroid Function Tests ; Thyroid Gland* ; Thyroiditis* ; Thyroiditis, Subacute* ; Thyrotoxicosis ; Thyrotropin

Acute suppurative thryroiditis is a rare disease because the thyroid gland is resistant to infection. Thyroid function tests are usually normal in acute suppurative thryroiditis. We care for a patient with acute suppurative thryroiditis and associated thyrotoxicosis. A 73-year-old diabetic woman presented with pain over the thyroid gland and an elevated serum thyroid hormone level and decreased radioiodine uptake, as occurs in subacute thyroiditis. A neck computed tomography showed an abscess in the right lobe of the thyroid gland. A neutrophilic infiltration was shown in a fine needle aspiration biopsy, and Gram negative Burkholderia gladioli grew from the aspirate culture. Antibiotic treatment ameliorated the symptoms of infection, followed by normalization of thyroid function.
Abscess ; Aged ; Biopsy ; Biopsy, Fine-Needle ; Burkholderia gladioli ; Female ; Humans ; Neck ; Neutrophils ; Rare Diseases ; Thyroid Function Tests ; Thyroid Gland ; Thyroiditis, Subacute ; Thyroiditis, Suppurative ; Thyrotoxicosis

Acute suppurative thyroiditis is an uncommon disease of thyroid, as thyroid gland is remarkably resistant to infection. In children, the most common route of infection is from a pyriform sinus fistula and then the inflammation spreads from the sinus to the perithyroidal space. It is important to differentiate acute suppurative thyroiditis with thyrotoxicosis from subacute thyroiditis. And if left untreated, acute suppurative thyroiditis can lead to thyroid abscess formation. A 11-year-old girl presented with acute illness of fever and tender neck swelling. Thyroid ultrasonogram and ultrasono-guided needle aspirated cytology confirmed acute suppurative thyroiditis. Although on computed tomography (CT) scan suggested acute suppurative thyroiditis due to pyriform sinus fistula, there was no evidence of fistula formation between thyroid and pyriform sinus on barium esophagogram. After treatment with antibiotics, she displayed clinical improvement and was discharged without complication. Here we report a child of acute suppurative thyroiditis with transient thyrotoxicosis controlled with antibiotics with literature review.
Abscess ; Anti-Bacterial Agents ; Barium ; Child* ; Female ; Fever ; Fistula ; Humans ; Inflammation ; Neck ; Needles ; Pyriform Sinus ; Thyroid Gland ; Thyroiditis, Subacute ; Thyroiditis, Suppurative* ; Thyrotoxicosis* ; Ultrasonography

No abstract available.
Fistula* ; Pyriform Sinus* ; Thyroiditis, Suppurative*