Acute suppurative thyroiditis caused by an infected piriform sinus fistula with thyrotoxicosis

Thyroid : Official Journal of the American Thyroid Association
Shuji FukataM Sugawara

Abstract

We report herein an unusual case of thyrotoxicosis caused by acute suppurative thyroiditis (AST) infected through a piriform sinus fistula (PSF). A 28-year-old man presented with pain over the thyroid gland and elevated serum thyroid hormone levels, a picture similar to subacute thyroiditis. A fine-needle aspiration biopsy from the left lobe showed neutrophil infiltration, and culture from the aspirate grew anaerobic peptostreptococcus. A neck computed tomography (CT) scan showed an abscess in the thyroid gland, and barium swallow revealed the presence of PSF. Appropriate antibiotic treatment ameliorated his symptoms of infection, followed by normalization of thyroid function. Three months later, he underwent fistulectomy and partial left lobectomy. The end of the PSF track was found in the left thyroid lobe. Thus infection of the thyroid gland through the infected PSF was likely the cause of supprative thyroiditis. The unusual clinical features of AST in this patient include the presence of severe thyrotoxicosis, relatively late onset (28-years-old) of infection despite the presence of congenital PSF, and the lack of acute inflammatory signs on the overlying skin of the thyroid gland. It is important to recognize this type of ...Continue Reading

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Citations

Nov 11, 2005·Thyroid : Official Journal of the American Thyroid Association·Eijun NishiharaKanji Kuma
Jan 13, 2006·Thyroid : Official Journal of the American Thyroid Association·Akira MiyauchiKanji Kuma
Jun 5, 2007·Thyroid : Official Journal of the American Thyroid Association·Kai-Jen TienShih-Chieh Hsin
Dec 6, 2011·Thyroid : Official Journal of the American Thyroid Association·Matthew SpitzerAlan P Farwell
Dec 12, 2012·Thyroid : Official Journal of the American Thyroid Association·Sumihisa KubotaAkira Miyauchi
Dec 2, 2011·Internal Medicine·Kana InoueIichiro Shimomura
Jan 30, 2007·Journal of Endocrinological Investigation·V Sicilia, S Mezitis
Jan 29, 2016·Pediatric Surgery International·Paulette I AbbasMonica E Lopez
Mar 27, 2012·The Medical Clinics of North America·Stuart C Seigel, Steven P Hodak
Oct 24, 2007·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·Thottathil GopanRobert S Zimmerman
Aug 1, 2014·Annals of Pediatric Endocrinology & Metabolism·Jee Hyue SeoHyun Young Kim
Jan 8, 2014·Endocrinology and Metabolism·Bo Sang KimDong Sun Kim
Jul 27, 2010·Nature Reviews. Endocrinology·Akira Miyauchi
Oct 29, 2005·Archives of Pathology & Laboratory Medicine·Natasha RekhtmanSyed Z Ali
Jul 20, 2021·Zeitschrift für Gerontologie und Geriatrie·A Büttner, M Galster
Feb 29, 2020·La Revue de médecine interne·A RoulandB Bouillet

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