Acute suppurative thyroiditis caused by Salmonella enteritidis

Acute suppurative thyroiditis in a 47-year-old diabetic woman is reported. Diagnosis was suspected by clinical examination and confirmed by ultrasound, CT-scan and cytological examination. A rare causative agent was isolated--Salmonella enteritidis. No signs of nodular goiter or connection with piriform sinus were found. In spite of our efforts, the source and route of infection remained unclear. However, the haematogenic route seems to be the most plausible. Surgical drainage and antibiotics brought about a complete recovery. Partial lesion of the gland required transitory administration of levothyroxine.

Tuberculous thyroiditis: report of a case with a review of the literature

A 49-year-old Japanese woman was referred to our department for evaluation of a thyroid nodule. She underwent subtotal thyroidectomy with modified neck dissection for a follicular thyroid carcinoma, suspected on preoperative diagnosis. The histological diagnosis was tuberculous thyroiditis. She made an uneventful recovery and received antituberculous agents. At follow-up she remains well and is euthyroid. Reports on forty-four patients in the Japanese literature were read. Tuberculous thyroiditis must be differentiated from thyroid cancer and subacute thyroiditis. Surgery plus administration of antituberculous drugs is considered the treatment of choice.

Acute thyroiditis caused by Moraxella nonliquefaciens

A 43-year-old woman presented with thyroiditis caused by Moraxella nonliquefaciens. Antibiotic therapy resulted in complete recovery. The literature on M. nonliquefaciens and acute bacterial thyroiditis is reviewed. This is the first documented case of a thyroiditis caused by M. nonliquefaciens.

Soluble CD antigen (cytokine) expression in various hyperthyroid states and use in the assessment of propylthiouracil treatment

The soluble CD antigens sCD8, sCD23, and sCD25 are increased in untreated Graves' hyperthyroidism. These levels remain elevated when euthyroidism is established in response to propylthiouracil (PTU) therapy but decrease to control values after PTU treatment is discontinued, when euthyroidism has been established and maintained. Neither sCD8 nor sCD23 are elevated in patients with euthyroid Graves' ophthalmopathy nor in the hyperthyroid phase of subacute thyroiditis. sCD25 is increased to an intermediate degree in these disorders. Soluble CD8 > or = 450 U/ml is sensitive, specific, and predictive of PTU success as sole therapy or need for definitive therapy in untreated and PTU-treated Graves' hyperthyroidism, exceeding the predictive values of thyroid-stimulating hormone receptor antibody, thyroid peroxidase antibody, and T3 radioimmunoassay.

Riedel's thyroiditis--case report and literature review

A fifty two year old female underwent attempted thyroidectomy for a progressively enlarging cervical swelling. At operation the thyroid gland was extensively fibrosed and not resectable, frozen section showed fibrous replacement. The patient was given a short course of postoperative corticosteroid therapy and was maintained on thyroid replacement therapy. Thirty months later the patient remains asymptomatic.

Recovery from lymphocytic hypophysitis associated with painless thyroiditis: clinical implications of circulating antipituitary antibodies

Lymphocytic hypophysitis usually occurs in the antepartum or postpartum period and recovery of pituitary dysfunction has not been documented in most cases reported previously. We present a 50-year-old woman with lymphocytic hypophysitis who spontaneously recovered from panhypopituitarism over 18 months with the disappearance of an intrasellar mass. Although lymphocytic hypophysitis is thought to be an autoimmune disease, the clinical and pathogenetic significance of circulating antipituitary autoantibodies has not been clarified. Antipituitary antibodies were studied by immunofluorescence in blood samples obtained during the whole clinical course in this particular patient. Antibodies against rat pituitary cytosol were positive during the period of hypopituitarism and became negative when pituitary function recovered. Antibodies reacting with intact prolactin-secreting rat GH3 and corticotropin-secreting mouse AtT-20 cells were also positive during her period of hypopituitarism. They remained positive for several years after the recovery of pituitary function. We conclude that circulating antibodies against rat pituitary cytosol are good markers of pituitary inflammation in this patient. The other point to be emphasized in this case is the simultaneous development of painless thyroiditis and lymphocytic hypophysitis. We have discussed the pathogenic relationship of these two diseases on the basis of similar cases reported previously.

[Invasive fibrous thyroiditis--Riedel's goiter. A review of the literature and a case report]

Invasive fibrous thyroiditis (Riedel's goitre) is a rare condition of an unknown aetiology. The condition was first described by Riedel in 1883. In 1904 Hashimoto described another condition of invasive fibrous thyroiditis. Since then it has been discussed if Hashimoto's thyroiditis and Riedel's goitre were one disease in different states or two different diseases. Hashimoto's thyroiditis is known to have an autoimmune aetiology and it can be seen together with pernicious anaemia. Co-existence of Riedel's goitre and pernicious anaemia has never been reported. The patient mentioned had both Riedel's goitre and pernicious anaemia, and was first treated with subtotal thyroidectomy, relapsed after one year and consequently received steroids. Such coexistence and the very good effect of steroids could be explained on the basis of Hashimoto's and Riedel's thyroiditis being one condition in different states and with an autoimmune aetiology. It is recommended that patients with Riedel's goitre are postoperatively treated with steroids.

Sclerosing cholangitis associated with multifocal fibrosis: a case report

The association of sclerosing cholangitis, retroperitoneal fibrosis, and Riedel's thyroiditis has been reported twice before, and on both occasions the authors successfully used steroids to control the fibrotic process. A further case of fibrosis with this triad of organ involvement in which a combination of surgery and steroid treatment has arrested disease progression is described. This suggests an inappropriate immune response in this type of fibrotic overlap syndrome.

Acute bacterial thyroiditis presenting as otalgia

A case of acute bacterial thyroiditis due to Haemophilus influenzae infection presenting as otalgia is reported. The features of this condition and the differential diagnosis from subacute (DeQuervains) thyroiditis are discussed.

Thyroiditis as the presenting manifestation of disseminated extrapulmonary Pneumocystis carinii infection

A 38-yr-old male with acquired immunodeficiency syndrome developed neck pain in association with mild hyperthyroidism and a diffusely enlarged thyroid gland. Radioactive iodine scanning was consistent with thyroiditis, and biopsy of the thyroid demonstrated the presence of pneumocystis carinii in thyroid tissue. Treatment with pentamidine followed by trimethoprim sulfamethoxazole led to rapid normalization of thyroid size in association with the development of hypothyroidism. This case illustrates the natural history of pneumocystis carinii thyroiditis and suggests that thyroid disease be added to the spectrum of human immunodeficiency virus-associated endocrine dysfunction.

Iodine-induced subacute thyroiditis with thyrotoxicosis presenting as fever of unknown origin

A 26-year-old woman with features of bulimia nervosa presented with fever of unknown origin, hepatomegaly, marked leukocytosis, and increased erythrocyte sedimentation rate. Following prolonged observation, slight tenderness over the thyroid gland and signs of thyrotoxicosis occurred. A thyroid scan demonstrated no isotope uptake and the patient admitted abusing an organic iodine preparation in order to control her weight. The diagnosis of iodine-induced subacute thyroiditis with thyrotoxicosis was, therefore, considered. A brief course of low-dose steroids normalized both thyroid function and hematological parameters. On followup evaluation, urinary iodine excretion and thyroid function tests were normal.

Comparison of atrophic and goitrous auto-immune thyroiditis in children: clinical, laboratory and TSH-receptor antibody studies

We studied the clinical features, laboratory and thyroid functions and thyrotropin (TSH)-receptor and thyroid-stimulation antibodies in 21 patients with atrophic auto-immune thyroiditis (AAT) and 48 patients with goitrous auto-immune thyroiditis (GAT) of childhood onset. The clinical features of patient with AAT were cessation of growth and obesity, while asymptomatic enlargement of the thyroid gland was the sole symptom in most patients with GAT. Although the ages at diagnosis were comparable in both groups, the estimated ages at onset were much lower in patients with AAT than in those with GAT. Patients with AAT exhibited more severe hypothyroidism when evaluated by serum thyroxine (T4), tri-iodothyronine (T3), TSH, cholesterol levels and basal metabolic rates. The 24 h 123I-thyroidal uptake was significantly lower in patients with AAT than in those with GAT. None of the 19 patients with AAT possessed TSH-binding inhibitor immunoglobulins (TBII). On the other hand, 3 of the 32 GAT patients tested, possessed weak to potent TBII activities. Three TBII-positive patients with GAT also possessed thyroid-stimulation blocking antibodies. These findings suggest that: 1. Pathogenesis of AAT in children whose onset of hypothyroidism was before puberty is not due to TSH-receptor blocking antibodies, which are often found in patients with AAT of postpubertal onset. 2. AAT in children is considered not to be due to the later stage of GAT. 3. Some patients with GAT possessed TSH-receptor blocking antibodies. The aetiology and pathogenesis of AAT in children have yet to be elucidated.

Post-partum thyroiditis can be painful

A patient with post-partum thyroiditis is described. She was a 22 year old with a negative family history of autoimmune thyroid disease who was noted to have a high titre of antithyroid microsomal antibody during pregnancy. She developed mild hyperthyroidism 8 weeks post-partum but at 12 weeks she had a mildly painful enlarged thyroid gland. At 20 weeks post-partum she had severe thyroidal pain with dysphagia. The thyroid was exquisitely tender to palpation. She was treated with L-thyroxine and the pain resolved within 4 weeks. This is the first report documenting pain in the thyroid as a feature of post-partum thyroiditis.

Acute suppurative thyroiditis in a malignant thyroid gland

A case of acute suppurative thyroiditis in a malignant thyroid gland is presented. The patient was an elderly woman with several years' history of pre-existing goitre. A diagnosis of acute suppurative thyroiditis was not difficult to make because clinical features of an infected thyroid swelling appeared obvious. With the help of intravenous antibiotics and early incision and drainage the patient did well and is now receiving radiotherapy.

Lingual thyroid and associated epiglottitis

A relatively rare genetic anomaly, lingual thyroid has a reported incidence of 1:100,000. Histologically, it may consist of normal or fetal-type tissue, and may show lymphoid infiltration. Differential diagnosis should include consideration of various benign and malignant diseases. We review diagnostic procedures as well as medical and surgical management, and present an illustrative case of lingual thyroid with associated epiglottitis.

Five patients with painless thyroiditis simultaneously developed in a nursery school

Painless (silent) thyroiditis (PT) occurred simultaneously in 1 male and 4 females aged 21 to 52 years working at a nursery school. Clinical symptoms did not include goiter, or pain or tenderness of the neck in any of the patients but were characterized by edema of the lower legs as well as palpitation and loss of body weight as observed in subacute thyroiditis. General blood analysis showed that all patients were negative for C-reactive protein (CRP) and 3 had mild impairment of liver function. Examination of thyroid function suggested transient thyrotoxicosis accompanied by a marked reduction in radioactive iodine uptake (RAIU), but antithyroglobulin hemagglutination antibody (TGHA) and antithyroid microsomal hemagglutination antibody (MCHA) were negative in all patients. Examination of various viral antibodies showed no significant changes in their titers. Thyrotoxicosis was transient and disappeared without treatment or by glucocorticoid administration. Our results suggested that PT observed in this study was caused by some environmental factor. The possibility of an unidentified virus as a factor cannot be ruled out.

[Riedel's struma and fibrous mediastinitis. Positive therapeutic responsiveness to corticoids]

In a 45-year-old man with chronic hepatitis B a fibrous mediastinitis developed originating from a Riedel's thyroiditis. Because of associated pleural effusion compression of a pulmonary vessel could not be excluded. Administration of corticoids, undertaken in the absence of general guidelines to treat the mediastinitis, achieved regression of the pleural effusion and the mediastinal changes, as well as shrinkage of the cervical fibrosis.

[Clinical and pharmacokinetic evaluation of imipenem/cilastatin sodium in children]

Nineteen episodes of infection in 17 children (one had 3 episodes) were treated with imipenem/cilastatin sodium (MK-0787/MK-0791), and the clinical efficacy and side effects were evaluated. The ages of patients ranged from 1 month to 8 years 1 month and their body weights ranged from 3.9 to 25.2 kg. The MK-0787/MK-0791 was administered intravenously by a 30-60 minutes infusion, in doses ranging from 8-42 mg/8-42 mg/kg every 6 to 12 hours for 3 to 40.5 days. Among 18 episodes in 16 patients (one patient proved to have rubella meningoencephalitis and was excluded from evaluation of the clinical efficacy) with bacterial infections including sepsis, pneumonia, acute suppurative thyroiditis and urinary tract infections, the results were excellent in 10, good in 5, fair in 2, and poor in 1 episode. Some side effects were noted; among all 19 episodes in the 17 patients diarrhea was noted in 3, rash in 1, slightly elevated serum transaminases in 1 and thrombocytosis in 1 episode. Pharmacokinetic studies were done in 7 patients whose ages ranged from 3 years 2 months to 13 years 1 month. Plasma concentrations of MK-0787 in 2 children were 19.6 and 20.0 micrograms/ml at 15 minutes and 5.6 and 2.1 micrograms/ml at 2 hours after a 10 mg/10 mg/kg intravenous 30-minute drip infusion of MK-0787/MK-0791. Plasma half-lives of MK-0787 were 1.52 and 0.74 hour, and total urinary recoveries were 54.6 and 71.4% during 0-6 hours. After a 20 mg/20 mg/kg intravenous 30-minute drip infusion into 2 other children, plasma concentrations of MK-0787 were 46.8 and 44.0 micrograms/ml at 15 minutes and 7.8 and 7.4 micrograms/ml at 2 hours. Plasma half-lives were 0.82 and 0.83 hour, and total urinary recoveries were 110.2 and 80.5% during 0-6 hours. Plasma concentrations of MK-0787 were less than 0.2, 0.2 and 1.2 micrograms/ml just before the next doses in 3 patients given 11-20 mg/11-20 mg/kg of MK-0787/MK-0791 every 6-8 hours. The time course of the plasma levels and urinary excretion in these patients were similar to those noted in the previous 4 patients following a single dose. Plasma concentrations of MK-0787 in a girl were 0.3 micrograms/ml just before the next dose and 8.2 micrograms/ml at 2 hours after multiple doses of 14 mg/14 mg/kg every 6 hours for 3 days and then 28 mg/28 mg/kg every 6 hours for 35 days.(ABSTRACT TRUNCATED AT 400 WORDS)