Acute infectious thyroiditis

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Acute infectious thyroiditis
Histopathological image of subacute thyroiditis
Synonyms	Suppurative thyroiditis, bacterial thyroiditis
Pronounce	N/A
Specialty	N/A
Symptoms	Neck pain, fever, dysphagia, hoarseness
Complications	Abscess, sepsis, airway obstruction
Onset	Sudden
Duration	Variable
Types	N/A
Causes	Bacterial infection, viral infection
Risks	Immunocompromised state, pre-existing thyroid disease
Diagnosis	Clinical examination, ultrasound, fine needle aspiration biopsy
Differential diagnosis	Subacute thyroiditis, Hashimoto's thyroiditis, Graves' disease
Prevention	N/A
Treatment	Antibiotics, surgical drainage
Medication	Antibiotics
Prognosis	Good with treatment
Frequency	Rare
Deaths	N/A

Acute Infectious Thyroiditis (AIT), also known as suppurative thyroiditis, is a rare form of thyroiditis resulting from an infectious process. It is characterized by rapid onset of symptoms which can include pain, swelling, and tenderness of the thyroid gland, systemic fever, and occasionally, abscess formation within the thyroid gland.

Etiology and Epidemiology

Most cases of AIT are caused by bacterial infections, with Staphylococcus aureus and Streptococcus species being the most common pathogens. Other potential causes include fungal and mycobacterial infections. AIT is more common in children and adolescents, especially those with pre-existing anatomical anomalies of the thyroid or neck region, such as pyriform sinus fistula.

Clinical Presentation

Patients with AIT commonly present with:

• Rapid onset of anterior neck pain and swelling
• Fever and systemic symptoms of infection
• Dysphagia (difficulty swallowing) or odynophagia (painful swallowing)
• Hoarseness due to compression of the recurrent laryngeal nerve
• Symptoms of hyperthyroidism or hypothyroidism might be present depending on the extent of gland involvement

Diagnosis

Diagnosis is primarily based on clinical presentation, laboratory findings (elevated white blood cell count, increased erythrocyte sedimentation rate), and imaging studies. Ultrasound of the thyroid may show heterogeneous areas with or without abscess formation. Fine needle aspiration (FNA) can be diagnostic as well as therapeutic in case of abscess formation.

Treatment

Antibiotic therapy targeting the identified or suspected organism is the mainstay of treatment. Surgical drainage may be required for large abscesses or if medical management fails. Long-term follow-up is necessary as some patients may develop hypothyroidism after resolution of the acute episode.

Prognosis

With prompt diagnosis and appropriate treatment, the prognosis for AIT is generally good. However, potential complications include spread of infection to adjacent structures, sepsis, and the development of hypothyroidism or thyroid scarring.

See Also

• Thyroiditis
• Thyroid gland
• Hypothyroidism

References

• "Acute Suppurative Thyroiditis: A Clinical Review" - Endocrinology and Metabolism Journal
• "Infectious Diseases of the Thyroid Gland" - The Thyroid: A Fundamental and Clinical Text

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