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Suppurative thyroiditis in children: a management algorithm

Stacey L Smith1, Kevin D Pereira

  • 1Department of Otolaryngology-Head and Neck Surgery, The University of Texas Health Science Center at Houston, Houston, USA.

Pediatric Emergency Care
|October 29, 2008
PubMed

Insights

Suppurative thyroiditis in children is rare and often linked to a piriform sinus tract. Early diagnosis via hypopharyngoscopy and treatment with cauterization or excision offers a cure.

Area of Science:

  • Pediatric Endocrinology
  • Otolaryngology
  • Infectious Diseases

Background:

  • Suppurative thyroiditis is an uncommon pediatric infection.
  • Left-sided intrathyroidal abscesses in children warrant suspicion for a piriform sinus tract.

Purpose of the Study:

  • To determine the causes of suppurative thyroiditis in pediatric patients.
  • To propose a management strategy for this condition.

Main Methods:

  • A case series involving 5 pediatric patients diagnosed with suppurative thyroiditis between 1999 and 2007.
  • Diagnostic tools included barium swallows and telescopic hypopharyngoscopy.
  • Treatment involved incision and drainage, tract excision, or silver nitrate cauterization.

Main Results:

  • All patients presented with left-sided intrathyroidal abscesses.
  • Piriform sinus tracts were identified in 2 patients via barium swallow and in all 5 via hypopharyngoscopy.
  • Treatments included abscess drainage, tract excision, or cauterization, leading to asymptomatic outcomes for all patients.

Conclusions:

  • Suppurative thyroiditis in children is rare and frequently associated with piriform sinus tracts.
  • Hypopharyngoscopy is crucial for diagnosing the internal opening of the tract.
  • Endoscopic cauterization of the internal opening is a safe, effective, and potentially curative treatment with minimal morbidity.
Abstract

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