Acute suppurative thyroiditis in an asymptomatic woman: an atypical presentation simulating thyroid carcinoma

Papillary thyroid carcinoma presenting as acute suppurative thyroiditis: A case report and review of the literature

Acute suppurative thyroiditis is a rare, potentially life-threatening condition. We report the case of a 17-year-old male who initially presented with a thyroid abscess. Due to persistent symptoms and lack of evidence for underlying predisposing factors, he was followed closely and subsequently diagnosed with papillary thyroid cancer. He was successfully managed with surgery. His clinical course, radiological evaluation, and pathology reports are presented here along with a review of the literature. This case of papillary thyroid cancer highlights the need for close follow-up of patients presenting with a thyroid abscess, when other predisposing risk factors are not evident.

Right-sided acute suppurative thyroiditis caused by infectious endocarditis

Acute suppurative thyroiditis is a rare disorder that is mostly found in the left lobe of the thyroid gland of children due to congenital patency of the pyriform sinus fistula. Here, we report a 61-year-old man with acute right-sided suppurative thyroiditis without pyriform sinus fistula. He also showed infectious hip arthritis, spondylitis and Roth's spots. He presented with heart failure and was diagnosed with infectious endocarditis by sequential transesophageal echocardiography. A replacement with a prosthetic valve was performed and cured him. It is important to recognize that infectious endocarditis can be a focus of acute suppurative thyroiditis.

Management of Congenital Third Branchial Arch Anomalies: A Systematic Review

OBJECTIVE: To systematically review the existing literature on third branchial arch anomalies and suggest guidelines for their management.

DATA SOURCES: We searched PubMed, Medline, and Embase using Scopus, and collected additional publications cited in bibliographies. We included all English-language articles and all foreign-language articles with an English abstract.

REVIEW METHODS: Two investigators reviewed all cases explicitly identified as third arch anomalies or meeting anatomical criteria for third arch anomalies; they assessed presentation, diagnostic methods, intervention, and outcome.

RESULTS: We found 202 cases of third arch anomalies; they presented primarily on the left side (89%), usually as neck abscess (39%) or acute suppurative thyroiditis (33%). Barium swallow, direct laryngoscopy, and magnetic resonance imaging were the most useful diagnostic tools. The recurrence rate varied among the treatment options: incision and drainage, 94 percent; endoscopic cauterization of the sinus tract opening, 18 percent; open-neck surgery and tract excision, 15 percent; and partial thyroidectomy during open-neck surgery, 14 percent. Complications after surgery appeared somewhat more frequently in children eight years of age or younger.

CONCLUSION: Third arch anomalies are more common than previously reported. They appear to be best treated by complete excision of the cyst, sinus, or fistula during a quiescent period. Repeated incision and drainage yields high rates of recurrence and should be avoided. Complications might be minimized by first initiating antibiotic treatment, delaying surgical treatment until the inflammatory process is maximally resolved, and by using endoscopic cauterization.

Diagnosis and Management of Infectious Thyroiditis

A broad range of disorders can cause inflammation of the thyroid gland. True thyroid infections are rare and can result from a variety of microorganisms, of which bacteria are the most common. Other rarer pathogens include fungi, parasites, and viruses. Gram-positive bacteria, especially staphylococci, predominate as causative agents in adults and children. In immunocompromised patients, opportunistic pathogens have been isolated. Most infections in adults occur as a result of hematogenous or lymphatic seeding of the thyroid gland. In children, congenital anomalies can lead to thyroid infection and require surgical correction to prevent recurrence. Fine-needle aspiration of the thyroid is usually required to identify the infecting agent, and prolonged antimicrobial therapy with or without surgical drainage is the cornerstone of management. This review outlines the pathogenesis, microbiology, diagnosis, and management of infectious thyroiditis in adults and children and compares this disorder with other, more common causes of thyroid inflammation.