Acute Suppurative Thyroiditis Treated Avoiding Invasive Procedures in a Child

Abstract

Acute suppurative thyroiditis is uncommon in children (1). Acute suppurative thyroiditis is a potentially life-threatening endocrine emergency. The management of this condition has recently been reviewed (2–4), but the optimal treatment is still debated. Surgery is the traditional treatment of this condition, but a nonsurgical management has also been reported (5). This case illustrates a successful conservative approach monitored by ultrasound (US) in a 4-yr-old girl. She came to our observation for a lump of more than 2 cm in the left side of the neck (Fig. 1A1). Ten days before she was admitted to a different institution for a left anterior neck mass. The mass was painful, tender, with erythema and warmth. She presented with fever (39 C) and leucocytosis (white blood cells, 22.100; neutrophils 85%) and was treated for acute suppurative thyroiditis with iv ampicillin and gentamicyn for a week. At our first observation she presented with a firm, painless lump of more than 2 cm in the left side of the neck (Fig. 1A1). At US (Fig. 1B1), the left lobe of thyroid was enlarged, and the parenchyma looked subverted, with a large irregular hypoechoic area and effacement of the planes between prethyroid muscles and soft tissues surrounding the lobe. Adjacent to the lump, a hypoechoic area in the soft tissue, presumably an abscess, was found (arrow). She was treated with amoxicillin and clavulanic acid (100 mg/kg/d per os) for 55 d. The lump disappeared (Fig. 1A2). At US (Fig. 1B2), nearly normal parenchyma was visible as well as muscles and soft tissues. The hypoechoic area was substituted with hyperechoic tissue (arrow). After 6 months she is well, and thyroid function is normal. A transnasal laryngoscopy to evaluate a possible pyriform sinus fistula is planned if a recurrence occurs.