Acute purulent thyroiditis

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Classification according to ICD-10
E06.0 Acute thyroiditis
purulent thyroiditis
ICD-10 online (WHO version 2019)

In the acute suppurative thyroiditis (also suppurative thyroiditis ) is a rare painful inflammation of the thyroid gland ( thyroiditis ), which is usually due to infection with bacteria (also see infectious thyroiditis).

Cause and development of the disease

The most common causative agents of acute purulent thyroiditis are the gram-positive bacteria Streptococcus pyogenes , Streptococcus pneumoniae and Staphylococcus aureus . They usually reach the thyroid tissue via the blood or lymph vessels ( haematogenic or lymphogenic route of infection). The main starting point is bacterial infections in the head and neck area (e.g. tonsillitis , otitis media and inflammation of the throat ). In addition, injuries to adjacent structures, such as the esophagus, can lead to an infection of the thyroid. Abscesses can form as part of the infection .

Clinical appearance

Acute purulent thyroiditis is characterized by severe sore throats, which are often lateral, and fever. The neck region above the thyroid is characterized by considerable tenderness. The inflammatory reaction can cause swelling of the thyroid gland and reddening of the throat.

Complications

Acute purulent thyroiditis can lead to serious complications such as blood poisoning ( sepsis ) and inflammation of the mediastinum ( mediastinitis ). With the introduction of antibiotic therapy, however, these complications have become very rare.

diagnosis

The diagnosis of "acute purulent thyroiditis" can be made relatively certain on the basis of clinical features (medical history and physical examination), laboratory parameters, ultrasound of the thyroid gland and microbiological examination of the material obtained in a fine needle aspiration .

Typical changes in a bacterial infection are typical for a blood test: increase in the inflammation parameters, i.e. above all the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as well as an increase in the number of white blood cells ( leukocytosis ) shifting to the left . The thyroid parameters (TSH and free thyroid hormones) can be changed in terms of mild hypo- or hyperthyroidism. The ultrasound shows an inhomogeneous picture, hypoechoic areas alternate with anechoic areas. Furthermore, any abscesses can be detected by the ultrasound examination. The fine needle aspiration is used to detect the pathogen and to prepare an antibiogram so that a sensible selection of antibiotics can be made.

therapy

Acute purulent thyroiditis is treated immediately because of the risk of serious complications. The therapy is carried out using a broad spectrum antibiotic . This antibiosis will be adjusted to the test result after the antibiogram is received. If an abscess is formed, surgical intervention to clear the abscess can be performed.

swell

  • AE Heufelder among others: The thyroiditis: Current status of the pathogenesis, diagnosis and therapy. Dtsch Arztebl 1998; 95 (9), pp. A-466 / B-394 / C-368. Online version
  • H. Mönig, B. Harbeck: Thyroiditis. In: DMW - German Medical Weekly. 133, 2008, pp. 301-304, doi: 10.1055 / s-2008-1046710 .