What Is Acute Thyroiditis?

Acute thyroiditis is an acute purulent infection of the thyroid gland, also known as acute purulent thyroiditis (AST). It is a non-specific infectious disease of the thyroid gland, which is rare in clinical practice. Caused by a bacterial, fungal, viral, or parasitic infection. Acute thyroiditis is more acute. Symptoms include high fever, sweating, sore throat, difficulty swallowing, and general discomfort. There is a local mass in the thyroid area, tenderness is obvious, and local skin is red and fever. Dugar et al. Proposed a triad of clinical manifestations: multinodular goiter, unilateral hypopharyngitis, and surrounding cellulitis.

Basic Information

nickname

Acute suppurative thyroiditis (AST)

Visiting department

Endocrinology

Multiple groups

Middle-aged woman

Common causes

Caused by a bacterial, fungal, viral, or parasitic infection

Common symptoms

Chills, fever, goiter, redness, tenderness, etc.

Causes of Acute Thyroiditis

It can be a single pathogenic infection or a mixed infection. The cause is mainly related to the following factors: secondary infection of basic thyroid disease; iatrogenic infections, such as inadequate disinfection during thyroid puncture; congenital malformations, the most common is congenital zygomorphic fistula, which occurs in children The main reasons are: inflammation directly spreading in the bloodstream or near the thyroid gland; oropharyngeal trauma; can also be seen in patients with immunodeficiency or immunodeficiency.

Clinical manifestations of acute thyroiditis

More common in middle-aged women. There was a history of upper respiratory tract infections such as sore throat, nasal congestion, headache, and general soreness more than 1 to 2 weeks before the onset. Sudden onset, symptoms of systemic poisoning in the acute phase, such as chills, fever, increased white blood cell count, etc., goiter, redness, tenderness, pain that occupies the ear pillow behind the ears, and worsens during movement or swallowing. Hissing, shortness of breath, and difficulty swallowing. If the purulent is swollen and bouncing, there may be a fluctuating sensation after purulent. Within a few days, you can see swelling of the thyroid gland, tenderness and pain spreading to the ears and occipital area. Severe cases can cause compression symptoms such as shortness of breath, hoarseness, and even difficulty swallowing. Necrosis of the glandular tissue and abscess formation can cause hypothyroidism. If it is not treated in time, the development of the abscess can penetrate the surrounding tissue, and it may be accompanied by purulent mediastinitis, tracheoesophageal fistula, and severe cases may be swallowed or have difficulty breathing due to abscess compression, which is life-threatening.

Acute thyroiditis examination

The total number of white blood cells and neutrophils in the acute phase increased, and the erythrocyte sedimentation rate accelerated. Thyroid function is more normal, and transient thyrotoxicosis can also occur. Generally, it can heal without treatment. A scan of the thyroid after abscess formation showed cold nodules or no radioactive distribution. Ultrasound of the thyroid helps diagnosis.

Acute thyroiditis diagnosis

Combined with clinical symptoms and blood routine, thyroid ultrasound can be diagnosed. The final clear diagnosis method is ultrasound-guided fine needle aspiration aspirate smear and etiology culture.

Differential diagnosis of acute thyroiditis

Neck collar

It is common in the lateral part of the neck and is close to the palate. It has the characteristics of redness, swelling and pain, and its location is limited. It is common in children.

2. Throat key

More common in children. At the beginning, the throat is red and swollen around the throat, the feet are scattered, the pain is hard and hot, the onset is fierce, and the systemic symptoms are severe.

3. Subacute thyroiditis

Symptoms such as neck pain and fever can also occur, but in general, AST is considered when patients have the following characteristics: swelling and pain in the anterior neck area on one side, mostly on the left side. Most thyroid function tests are within the normal range; however, it is worth noting that AST cannot be completely ruled out even if the thyroid function is abnormal. Fine needle puncture of AST under ultrasound to obtain pus, and the pathogen can be obtained from the culture of the puncture substance; if the puncture objective microscope shows granuloma and mononuclear cell infiltration rich in multinucleated giant cells, it indicates subacute thyroiditis.

Acute thyroiditis treatment

The AST treatment principle emphasizes anti-infective therapy combined with surgical intervention. Once the diagnosis is made at the beginning of the onset, a broad-spectrum antibiotic empirical treatment should be selected first, and the antibiotics should be further adjusted after the puncture pathogen culture results. It is generally believed that if the AST is complicated by a basic disease or congenital malformation, it is difficult to control the infection, and the antibiotic course should be sufficient for at least 2 to 3 weeks. After abscess formation, pus should be discharged in time on the basis of strengthening anti-infective treatment. In addition, for patients with piriformis fistula found by barium swallowing or throat endoscopy, the fistula should be surgically removed after the AST has subsided.