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Clinical characteristics and management of acute suppurative thyroiditis in children
Pin Chang1, Wen-Yu Tsai, Ping-Ing Lee
1Department of Pediatrics, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
Insights
Acute suppurative thyroiditis in children is often linked to pyriform sinus fistula (PSF). Streptococcus species are common pathogens, and amoxicillin-clavulanate is the recommended treatment.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Endocrinology
Background:
- Acute suppurative thyroiditis is a rare pediatric condition.
- This study reviews 11 cases treated over 15 years at a major hospital.
Purpose of the Study:
- To describe the clinical features and management of pediatric acute suppurative thyroiditis.
- To identify causative pathogens and predisposing factors like pyriform sinus fistula (PSF).
- To evaluate treatment efficacy.
Main Methods:
- Retrospective analysis of 11 children diagnosed with acute suppurative thyroiditis (1985-2000).
- Assessment of clinical data, laboratory tests (leukocyte count, acute-phase reactants, thyroid function, autoantibodies).
- Diagnostic procedures included thyroid needle aspiration for cytology/culture and barium esophagogram to detect PSF.
Main Results:
- Pyriform sinus fistula (PSF) was identified in 80% of examined patients.
- Streptococcus species and anaerobic organisms were the most common pathogens.
- Amoxicillin-clavulanate demonstrated sensitivity against isolated microorganisms.
Conclusions:
- Pyriform sinus fistula (PSF) is a significant factor in pediatric acute suppurative thyroiditis.
- Streptococcus species are the predominant causative agents.
- Amoxicillin-clavulanate is the preferred antibiotic treatment for this condition.
Background:
Acute suppurative thyroiditis is an uncommon disease in children. This paper describes the clinical characteristics and management of children with acute suppurative thyroiditis treated during a 15-year period at National Taiwan University Hospital.
Patients And Methods:
From 1985 to 2000, acute suppurative thyroiditis was diagnosed in 11 previously healthy children (6 boys, 5 girls) at the Department of Pediatrics. Their mean age at diagnosis was 6.4 +/- 4.4 years. Leukocyte count, acute-phase reactants, thyroid function, and thyroid autoantibodies were assessed. Samples were taken by thyroid needle aspiration for cytology study and pus culture. Underlying pyriform sinus fistula (PSF) was demonstrated by barium esophagogram.
Results:
Leukocytosis was noted in six cases (55%) and acute-phase reactants were elevated in eight cases (73%). Neither thyroid autoantibodies nor thyroid dysfunction was detected in any of the patients. Barium esophagogram detected PSF in eight of 10 patients examined. Five (45%) patients had recurrent suppurative thyroiditis before surgery. Cytology and pus cultures were available for 10 patients. Polymorphonuclear cells were the main findings in the smear from thyroid aspirates. Twenty-two organisms were isolated from six patients (60%). Streptococcus species (45%) and anaerobic organisms (41%) were the most common pathogens isolated. Mixed infection was detected in five of six children who had a causative microorganism identified. The microorganisms were all sensitive to amoxicillin-clavulanate.
Conclusion:
PSF plays a role in the pathogenesis of acute suppurative thyroiditis in children. Streptococcus species are the most common pathogens in acute suppurative thyroiditis. Our results suggest that amoxicillin-clavulanate is the drug of choice for the treatment of this disease.