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BMC Endocr Disord. 2019; 19: 130. Published online 2019 Dec 3. doi: 10.1186/s12902-019-0458-0PMCID: PMC6889346PMID: 31791298Acute suppurative thyroiditis with thyroid abscess in adults: clinical presentation, treatment and outcomesHenrik Falhammar,1,2 Göran Wallin,1,3 and Jan Calissendorff1,2Henrik Falhammar 1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden 2Department of Endocrinology Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden Find articles by Henrik FalhammarGöran Wallin1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden 3Deptartment of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden Find articles by Göran WallinJan Calissendorff1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden 2Department of Endocrinology Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden Find articles by Jan CalissendorffAuthor information Article notes Copyright and License information PMC Disclaimer1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden 2Department of Endocrinology Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden 3Deptartment of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden Jan Calissendorff, Email: [email protected] author.Received 2019 Sep 14; Accepted 2019 Nov 18.Copyright © The Author(s). 2019Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Associated DataData Availability StatementAll data generated or analyzed during this study are included in this published article. AbstractBackgroundAbscess in the thyroid gland is a rare but severe infectious disease. The condition can have anatomic or iatrogenic underlying causes. If untreated it could be fatal. Pathogens vary considerably. Treatment is intravenous antibiotics, drainage, and sometimes surgery. MethodsThe electronic medical records of all adult patients with acute thyroiditis 2003–2017 treated at the Karolinska University Hospital (catchment area 2 million) in Sweden were systematically reviewed. ResultsFive patients were found in the catchment area. One patient from another region but known to us was also included. Thus, six patients (aged 28–73 years) were included in the study. Median length of hospital stay was 7.5 days (4–79 days). All were treated with antibiotics (intravenous n = 5, oral n = 1). Total antibiotic treatment duration was 13.5 days (10–41 days). Blood cultures were positive in three (streptococcus pneumonia, streptococci sanguineous, pepto streptococci), deep tissue culture in three (Escherichia coli, Candida, Hemophilic influenza) and no positive culture at all in two. Drainage was used in three patients. All patients recovered without recurrences. Surgery was performed twice in the acute phase in one. There was no recurrence during 7 years (3–12) of follow-up, but one patient died after three years (severe heart failure and pneumonia). ConclusionThyroid abscess in adults is extremely rare nowadays in the developed world. With prompt antibiotic therapy, drainage and in some cases thyroidectomy the prognosis seems favourable. Keywords: Abscess, Infection, Surgery, Antibiotic treatment, DrainageIntroductionAcute suppurative thyroiditis (AST) is an infection in the thyroid gland progressing to an abscess. This is a serious, rare and potentially fatal condition [1]. Due to the encasement of the gland, its rich blood supply, high iodine content and good lymphatic drainage the thyroid is relatively resistant to most infections [2]. AST comprises Table 1 Laboratory measures, clinical signs and cultures in patients with thyroid abscess CRP mg/LESR mm/hrFever ºCTSH mIU/LFree T 4 pmol/LTRAb mIU/LTPOab kIU/LTissue culturesBlood culturesFNACase 118028–75400.115NegNegNAStrep pneumoniaLymphocytes, granulocytes macrophagesCase 232812737.90.0857NegNAE coliNeg × 6Granulocytes cell debrisCase 310440381.413 |
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