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SUBACUTE THYROIDITIS IN A CHILD
Insights
Subacute thyroiditis (SAT) in children presents with painful thyroid enlargement and thyrotoxicosis. Prompt diagnosis and corticosteroid treatment are key for symptom resolution.
Area of Science:
- Pediatric Endocrinology
- Thyroidology
- Inflammatory Disorders
Background:
- Subacute thyroiditis (SAT) is a rare pediatric thyroid condition.
- It can be misdiagnosed as acute suppurative thyroiditis, a more common pediatric condition.
Observation:
- A 7-year-old female presented with painful thyroid enlargement, fever, and thyrotoxicosis.
- Initial CT scan suggested an abscess, but ultrasound confirmed SAT.
- Treatment with antibiotics was ineffective, while NSAIDs provided temporary relief.
Findings:
- Laboratory tests revealed elevated inflammatory markers and free thyroxine, with suppressed TSH.
- Prednisolone at 1 mg/kg effectively resolved symptoms of pain and fever.
- Thyroid ultrasound is crucial for differentiating SAT from bacterial thyroiditis.
Implications:
- Accurate differentiation between SAT and acute bacterial thyroiditis is critical in pediatric practice.
- Corticosteroids are effective for managing pediatric subacute thyroiditis.
- This case highlights the importance of imaging and clinical presentation in diagnosing SAT in children.
Objective:
The objective of this report is to describe the presentation, disease course, and management of subacute thyroiditis (SAT) in children. SAT is a rare cause of thyroiditis in children and can be mistaken for acute suppurative thyroiditis, which may be more common in pediatrics.
Methods:
We present a 7-year-old female, who had painful thyroid enlargement, fever, and thyrotoxicosis.
Results:
Laboratory evaluation showed high white blood count, erythrocyte sedimentation rate, and free thyroxine levels. Thyroid-stimulating hormone was low. A computed tomography scan of the neck showed intrathyroidal fluid collection consistent with an abscess. She was treated with clindamycin, with no relief of fever and pain. Thyroid ultrasound showed diffuse enlargement of the thyroid lobes with hypoechoic areas, and no fluid accumulation, consistent with SAT. She was treated with intravenous ketorolac with relief of pain and fever, but these symptoms recurred when she was changed to oral ibuprofen. Her symptoms resolved with prednisolone at 1 mg/kg.
Conclusion:
Based on the limited number of reports in the literature, SAT in children appears to be unusual and may be less common than acute bacterial thyroiditis. In pediatric practice it is important to make the distinction between SAT and acute bacterial thyroiditis.
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