Suppurative thyroiditis in children and adolescents
- Itzhak Brook, MD, MSc
Itzhak Brook, MD, MSc
- Adjunct Professor, Department of Pediatrics
- Georgetown University School of Medicine
- Section Editors
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
- Mitchell E Geffner, MD
Mitchell E Geffner, MD
- Section Editor — Pediatric Endocrinology
- Professor of Pediatrics
- Keck School of Medicine, University of Southern California
Suppurative thyroiditis (ST) is caused by an infection of the thyroid gland (usually bacterial), and is rare, but potentially life-threatening [1-3]. The disease is far less common than other inflammatory conditions of the thyroid gland, including subacute granulomatous thyroiditis (which results from a viral infection of the gland) and chronic thyroiditis (which is usually autoimmune in nature). The signs and symptoms of ST may mimic these and other noninfectious inflammatory conditions. Recognition of the clinical and bacteriological features of ST is essential for prompt management.
The primary treatment for ST is antimicrobial therapy, directed against the likely bacterial pathogens. Although most cases of ST are caused by aerobic bacteria, anaerobic bacteria are increasingly recognized as a cause of ST, and this has led to revision of treatment protocols for this condition. Rarely, mycobacteria, fungi, or other nonbacterial pathogens may cause a subacute form of suppurative thyroiditis.
The pathogenesis, diagnosis, and treatment of acute suppurative thyroiditis in children are discussed here; subacute forms of suppurative thyroiditis are discussed briefly. The diagnosis and treatment of other inflammatory conditions of the thyroid gland, including subacute granulomatous thyroiditis and chronic thyroiditis, are discussed separately. (See "Clinical manifestations and diagnosis of hyperthyroidism in children and adolescents", section on 'Differential diagnosis of thyrotoxicosis' and "Overview of thyroiditis", section on 'Subacute thyroiditis' and "Acquired hypothyroidism in childhood and adolescence", section on 'Chronic autoimmune (Hashimoto’s) thyroiditis'.)
The thyroid gland is relatively resistant to infections . The rarity of thyroid infection has been explained by the high concentration of iodine within the gland, ample supply of blood and lymphatics, and the anatomical isolation of the gland from other neck structures. This isolation is due to the capsule around the thyroid gland and the lack of direct communication with neighboring structures. All of these features make the thyroid gland relatively resistant to infection by direct extension from contiguous sites [1,2].
Pyriform sinus fistula — In children, a fistula from the pyriform sinus associated with a third or fourth branchial arch anomaly  is a common route through which bacteria infect the thyroid gland (image 1) [5-7]. This type of fistula extends from the pharynx to the thyroid capsule and is almost always left-sided; the anomaly is particularly likely to be found in children with recurrent or left-sided ST. For a child with a pyriform sinus fistula presenting with a first episode of suppurative thyroiditis, the risk of recurrent thyroiditis has not been established, but appears to be high [5,6,8,9].
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