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[Thyroid abcess. Apropos of 5 cases]
1Service de Chirurgie Générale et Digestive, Hôpital de la Pitie, Paris.
Abstract:
Thyroid abcess and acute suppurative thyroiditis are uncommon, representing 0.1 to 0.7% of surgically treated thyroid pathologies. More common in children than in adults, this rarity is associated with poorly indicative clinical symptoms, thus making diagnosis difficult. Five cases reports are presented, 4 of them in adults, illustrating the diagnostic difficulties and the various etiopathological mechanism, thereby explaining the wide diversity of pathogenic agents responsible. Treatment includes surgery (drainage or (partial) thyroidectomy, depending upon the presence or not of an underlying thyroid pathology) and intravenous antibiotics. It is absolutely necessary to eliminate the source of the infection, often a piriform sinus fistula whose total resection effectively prevents a relapse (1 case in this series).
Insights
Thyroid abscess and acute suppurative thyroiditis are rare but challenging diagnoses due to vague symptoms. Prompt surgical intervention and antibiotics, addressing underlying causes like piriform sinus fistula, are crucial for effective treatment and preventing recurrence.
Area of Science:
- Endocrinology
- Infectious Diseases
- Surgical Pathology
Context:
- Thyroid abscess and acute suppurative thyroiditis are uncommon, accounting for 0.1–0.7% of surgically treated thyroid conditions.
- These conditions are more prevalent in children than adults, presenting diagnostic challenges due to subtle clinical manifestations.
Purpose:
- To present five case reports, including four adult cases, highlighting the diagnostic complexities.
- To illustrate diverse etiopathological mechanisms and responsible pathogenic agents in thyroid infections.
- To emphasize the importance of surgical treatment and antibiotic therapy, including addressing underlying causes like piriform sinus fistula.
Summary:
- The study details five cases of thyroid abscess/acute suppurative thyroiditis, underscoring diagnostic difficulties and varied causes.
- Treatment strategies involve surgical drainage or thyroidectomy combined with intravenous antibiotics.
- Complete resection of the piriform sinus fistula, a common source, is vital for preventing relapse.
Impact:
- Improved understanding of rare thyroid infections aids in earlier and more accurate diagnosis.
- Highlights the necessity of a comprehensive treatment approach, including addressing anatomical abnormalities.
- Effective management strategies can significantly reduce morbidity and prevent recurrent infections.