Medline ® Abstract for Reference 52
of 'Suppurative thyroiditis in children and adolescents'
Suppurative thyroiditis in children: a management algorithm.
Smith SL, Pereira KD
Pediatr Emerg Care. 2008;24(11):764.
OBJECTIVE: To elucidate the etiology of suppurative thyroiditis in children and recommend a management algorithm.
METHODS: Case series of 5 pediatric patients with a diagnosis of suppurative thyroiditis seen between January 1999 and April 2007.
RESULTS: All 5 patients primarily presented with left-sided intrathyroidal abscesses. The number of infections from first presentation to the time of definitive diagnosis ranged from 1 to 5. Three patients underwent incision and drainage of the abscess once, and 2 had the procedure performed 3 times. Barium swallows identified a piriform sinus tract on the left side in 2 of the 5 patients. Telescopic hypopharyngoscopy identified the internal opening in all 5. Three were managed with complete excision of their tracts and 2 with cauterization of the internal opening with silver nitrate. All 5 are currently asymptomatic.
CONCLUSIONS: Suppurative thyroiditis is a very rare infection in children. A left-sided intrathyroidal abscess should immediately arouse suspicion of a piriform sinus tract. Barium swallows may identify the etiology in some cases. Definitive diagnosis requires a hypopharyngoscopy, with detailed telescopic examination of the left piriform fossa apex. Endoscopic chemical cautery of the internal opening is a safe and effective technique, with very low morbidity, and has the potential for cure.
Department of Otolaryngology-Head and Neck Surgery, The University of Texas Health Science Center at Houston, Houston, USA.