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Acute suppurative thyroiditis in children
Insights
Thyroid abscesses are rare in children, often presenting as neck swelling. Early diagnosis and treatment, including cultures and surgery, are crucial for recovery.
Area of Science:
- Pediatric Endocrinology
- Infectious Diseases
- Otolaryngology
Background:
- Thyroid gland infections are uncommon in children.
- Acute suppurative thyroiditis and thyroid abscesses are rare pediatric conditions.
Observation:
- Two pediatric cases of thyroid abscess presented with painful neck swellings.
- Literature review identified only 21 reported cases in the past 25 years.
- One case involved an internal fistula from the pyriform sinus, suggesting a fourth branchial arch remnant.
Findings:
- Effective management involves diagnostic studies, appropriate cultures (bacterial, fungal, acid-fast), antibiotic therapy, and definitive surgery.
- Early recognition and intervention are key to successful outcomes.
Implications:
- Highlights the importance of considering rare diagnoses like thyroid abscess in pediatric neck masses.
- Emphasizes the need for comprehensive diagnostic workups and multidisciplinary management approaches.
- Suggests a potential link between branchial arch anomalies and pediatric thyroid infections.
Abstract:
The ability of the thyroid gland to withstand infection is a well known phenomenon. In this regard, inflammatory disease of the thyroid gland in children is an uncommon occurrence. The frequency with which this proceeds to abscess formation is rare. Review of the literature of the past 25 years reveals only 21 reported cases of acute suppurative thyroiditis in children, only one of which has been reported in the otolaryngologic literature. We report two cases of thyroid abscess in children initially presented as painful swellings in the lower neck. An overview of the management of these patients is detailed, including a discussion of the appropriate utilization of diagnostic studies. Demonstration of an internal fistula originating from the pyriform sinus underscores the need to consider a fourth branchial arch remnant as a possible source of infection. The importance of obtaining appropriate bacterial, fungal, and acid-fast cultures is stressed, as is the role of antibiotic therapy and definitive surgery once the diagnosis of thyroid abscess is made.