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The tender neck: thyroiditis or thyroid abscess?

D J Houghton1, H W Gray, K MacKenzie

  • 1Department of Otolaryngology, Head and Neck Surgery, Glasgow Royal Infirmary University NHS Trust, UK.

Clinical Endocrinology
|June 26, 1998
PubMed
Summary
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Recurrent thyroid abscesses in a teen were linked to a congenital fourth branchial sinus tract. Surgical excision of the sinus tract resolved the infection, highlighting the importance of barium swallows for diagnosing such rare thyroid conditions.

Area of Science:

  • Endocrinology
  • Surgical Pathology
  • Pediatric Otolaryngology

Background:

  • Thyroid abscesses are rare, particularly in adolescents.
  • Congenital anomalies, such as branchial cleft remnants, can predispose individuals to recurrent infections.

Observation:

  • A 16-year-old female presented with recurrent left thyroid abscesses following subacute thyroiditis.
  • Initial treatment included steroids and management of a pilonidal abscess, but infections persisted, necessitating partial thyroidectomy.
  • Persistent neck abscesses led to a barium swallow, revealing a patent fourth branchial sinus tract originating from the piriform fossa.

Findings:

  • The source of the recurrent thyroid and neck suppuration was identified as a congenital fourth branchial sinus tract.
  • Surgical excision of the patent fourth branchial sinus tract successfully resolved the infectious process.

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Implications:

  • Ultrasound-guided fine needle aspiration is crucial for diagnosing tender thyroid conditions, especially suspected suppuration.
  • In cases of confirmed thyroid suppuration, a barium swallow is recommended to rule out an underlying piriform fossa sinus tract, preventing recurrent infections.