Purulent Thyroiditis-a Clinical Study of 5 Cases

Abstract

Between 1 January 1990 and 31 December 2006, 13279 patients were operated on due to various forms of goitre, of which five cases were diagnosed with purulent thyroiditis-one child aged 8, three women and one man all between 35 and 81 years of age. The course of the disease was unusual. In three of the patients cancer was suspected. In all of the patients hard nodules were discovered within the thyroid gland, ultrasonographically heterogeneous and hypo-echogenic, although scintigraphic examination showed “cold” nodules. The child presented regional lymph node enlargement. Except in one case, all patients were apyretic.The rapid growth of the thyroid gland and symptoms of compression were observed in 2 cases. In one of them, trache-ostomy was required. Fine needle aspiration biopsy of the thyroid gland revealed the presence of profuse purulent infiltration in one case. Neither thyroid dysfunction nor autoimmune changes were detected. A subtotal thyroidectomy was performed in all patients. In the paediatric case, the enlarged lymph nodes were also resected. In 3 cases, thyroid abscess was diagnosed and drained and staphylococcus epidermidis, streptococcus epidermidis and streptococcus pyogenes were found. Microscopic examination proved the presence of aspergillus fumigatus in one case. Antibiotic therapy was applied postoperatively and all the patients recovered.Conclusions: 1. The clinical course of purulent thyroiditis leads to a diagnostic challenge. The surgical treatment of purulent thyroiditis allows for a faster recovery for the patient.