The risk of infective thyroiditis in nodular goitres

Infective thyroiditis which was more common in the pre-antibiotic era is now rare in developed countries but continues to occur in less developed areas. Over a 10-year period in Zaria, Nigeria which is situated in an endemic goitre region, nine such patients were treated. All were females, 30-50 years of age and had pre-existing, long-standing multinodular goitres. During the period, 84 patients (including the nine patients) with endemic multinodular goitres were treated, giving an infective rate of 10.7% in these goitres. Treatment was by adequate incision and drainage in all patients with suppuration. Staphylococcus aureus was the commonest organism cultured and Streptococcus Pyogenes and Pseudomonas were the infective agents in a minority. Only one patient required thyroidectomy later, the goitre having disappeared in the other patients. One patient developed hypothyroidism requiring replacement therapy with thyroxine. Thyroid abscess remains an ever present risk in endemic multinodular goitres in our environment. Early presentation after onset of pain, prompt administration of appropriate antibiotics and thyroidectomy soon after is likely to reduce the risk of abscess formation in these goitres.