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[Acute suppurative thyroiditis in a patient with prior subacute thyroiditis].

M Pantaleoni1, A Velardo, A Smerieri

  • 1Cattedra di Endocrinologia, Policlinico, Università degli Studi di Modena.

Minerva Endocrinologica
|July 1, 1992
PubMed
Summary

Acute suppurative thyroiditis, a rare bacterial infection, can arise from a pyriform sinus fistula. Prompt antibiotic treatment following diagnosis led to symptom resolution in this case.

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Area of Science:

  • Endocrinology
  • Infectious Diseases
  • Otolaryngology

Background:

  • Acute suppurative thyroiditis is an uncommon bacterial infection of the thyroid gland.
  • A congenital fistula from the pyriform sinus is the most frequent cause.
  • Pre-existing thyroid conditions like nodular goiter are often associated.

Observation:

  • A 44-year-old male with a history of subacute thyroiditis presented with recurrent fever and painful thyroid swelling.
  • Clinical examination revealed neck swelling, erythema, warmth, and dysphagia, with neutrophilia and normal thyroid function tests.
  • Ultrasonography showed thyroid lobe enlargement with inhomogeneous parenchyma, and a thyroid scan revealed a cold area.

Findings:

  • The patient was diagnosed with acute suppurative thyroiditis and treated with antibiotics.

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  • Following antibiotic initiation, the patient expectorated purulent material, leading to symptom improvement.
  • Indirect laryngoscopy identified a fistula opening in the hypopharynx.

    • Implications:

    • This case highlights the importance of considering pyriform sinus fistulas in recurrent or atypical thyroiditis presentations.
    • Early diagnosis and appropriate antibiotic therapy are crucial for managing acute suppurative thyroiditis.
    • Identifying the fistula is key to preventing recurrence and ensuring successful treatment.