Introduction:
Thyroiditis represents a group of conditions that cause inflammation of the thyroid gland. This condition can lead to the underproduction of thyroid hormone. Acute suppurative thyroiditis is one of the rare conditions of thyroid infection. Bacteria mainly cause this infection, but it can also occur due to some fungal or parasitic infection. It is primarily seen in the immunocompromised patient (the person whose immunity is low and is more susceptible to infections or diseases).
What Is Thyroiditis?
Thyroiditis is the inflammation of the thyroid gland due to bacteria or other microorganisms. The thyroid is a small butterfly-shaped gland in the front of the neck. It is an important gland that helps in various essential body functions by releasing certain hormones.
Thyroiditis includes many individual conditions that cause the inflammation of the thyroid gland, but these conditions have different causes and symptoms. However, they certainly impact the functioning of the thyroid gland and hampers the secretion of thyroid hormones.
What Are the Three Phases of Thyroiditis?
Thyroiditis involves three phases that occur in almost every thyroiditis infection, which are as follows:
1. Thyrotoxic Phase: In this phase of infection, the thyroid gland gets inflamed and releases too much hormone, leading to temporary thyrotoxicosis (a condition with too much thyroid hormone in the body).
2. Hypothyroid Phase: Due to the excess secretion of thyroid hormones for months or weeks, the thyroid levels decrease as there will not be enough thyroid hormone to secrete. This leads to a lack of thyroid hormones, or this condition is also called hypothyroidism.
3. Euthyroid Phase: In this phase, the thyroid hormones are normal, and this phase comes after the thyrotoxic phase before going to the hypothyroid phase. Also, it may come at the end when the thyroid gland has recovered from the inflammation and can maintain an average hormone level in the body.
What Is Acute Suppurative Thyroiditis?
Acute suppurative thyroiditis is a type of thyroiditis that is not that commonly seen. It is also known as infectious thyroiditis, microbial inflammatory thyroiditis, pyogenic thyroiditis, and bacterial thyroiditis. This type of infection is painful and progresses rapidly, affecting children and adults.
What Are the Causes of Infectious Thyroiditis?
1. Infectious or suppurative thyroiditis is caused mainly by a bacterial infection. The thyroid gland usually is highly resistant to infections, but still, it is susceptible to some bacteria like:
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Staphylococcus aureus.
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Streptococcus pyogenes.
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Staphylococcus epidermidis.
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Streptococcus pneumoniae.
2. Acute suppurative thyroiditis is commonly seen in patients with a prior history of thyroid diseases, such as Hashimoto's thyroiditis (an autoimmune disorder in which the immune system attacks the thyroid gland) or thyroid cancer.
3. The most common cause of infectious thyroiditis is pyriform sinus fistula, a rare congenital (from birth) abnormality around the areas of the nose, mouth, and neck, exposing the thyroid to infectious bacteria leading to the formation of cervical abscesses in children.
4. The cases of infectious thyroiditis are still very low, and they usually occur in immunocompromised patients.
5. Less common infections from mycobacteria and fungi are also seen in immunocompromised patients.
Some other causes of infectious thyroiditis are contamination from outside sources, which are
1. Repeated fine needle aspirates (aspiration or removal of fluid from the body).
2. Perforation of the esophagus (during any surgery or due to injury).
What Are the Symptoms of Acute Suppurative Thyroiditis?
Acute suppurative thyroiditis can occur in both children and adults. Acute infections are fast-acting infections and can cause symptoms within a short time, and the symptoms can also get from mild to severe quickly. Some of the symptoms related to infectious thyroiditis are:
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Rapid onset of pain and tenderness in one side of the neck.
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Fever and chills.
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Enlarged thyroid gland or swelling in the neck area.
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A movable lump or swelling in the neck.
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A warm, red, or tender area in the neck.
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Pain during swallowing.
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Swollen lymph glands.
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And some patients can also develop hypothyroidism (low thyroid hormone function) or hyperthyroidism (excess thyroid hormone function). However, thyroid function is likely to remain stable during acute infectious thyroiditis.
What Are the Complications Related to Acute Suppurative Thyroiditis?
Infectious thyroiditis can cause many complications, and the most common of them is an abscess (pus) formation, which turns out to be tough to treat with only antibiotics.
Other than that, some other complications involved are:
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Systemic infection (rare complication), in this condition, the infection can spread to other parts of the body.
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Bleeding into the thyroid gland is another complication resulting in swelling and damage to the thyroid gland.
What Are the Risk Factors Related to Acute Suppurative Thyroiditis?
Some of the risk factors related to infectious thyroiditis are as follows:
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Time of Year- This infection is more common in the winter or fall season, more commonly when a person has an upper respiratory infection.
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Age- Infectious thyroiditis is most common in young adults and middle age and tends to decrease with age.
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Weak Immune System- A person might have a weak immune system due to other diseases or conditions that make them more susceptible to thyroiditis, such as HIV/AIDS, or medicines like immunosuppressive and chemotherapy drugs.
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Thyroid Cancer- It increases the risk of developing acute thyroiditis.
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Intravenous (IV) Drug- IV drug (from a vein of the arms) is also one of the reasons for developing a severe bacterial infection leading to acute suppurative thyroiditis.
How Is Acute Suppurative Thyroiditis Diagnosed?
If acute suppurative thyroiditis is suspected in a patient, the doctor will advise a thorough examination which includes the following diagnostic processes:
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Physical Examination- The healthcare provider will examine the neck of the patient and look for any sign of infection. Next, the doctor will gently palpate (feel) the neck, thyroid gland, and nearby lymph nodes to check for any swelling or irregular growth. The most common signs of infectious thyroiditis are fever and pain in the neck.
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Diagnostic Imaging Tests- Imaging tests such as MRI (magnetic resonance imaging), CT scan (computerized tomography), or neck ultrasound can be prescribed by the healthcare provider to identify whether the symptoms are caused by thyroiditis or some other infection involving the neck.
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Blood Tests- Blood tests such as CBC (complete cell count) can show elevated levels of WBCs (white blood cells), indicating an infection. And blood culture can also be done to check the growth of bacteria or other microorganisms.
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Fine Needle Aspiration- This technique helps identify whether the thyroiditis is suppurative (containing pus) or non-suppurative. Fine needle aspiration (FNA) is a procedure in which fluid or pus is withdrawn from the body from the infected site to diagnose the infection. Then, the sample is analyzed in the lab to check the type of microorganism; according to that, the doctor prescribes the appropriate antibiotics or antifungals for the treatment.
What Is the Treatment for Acute Suppurative Thyroiditis?
The treatment for acute suppurative thyroiditis involves eliminating the infection and reducing the symptoms. The usual treatment for eradicating acute suppurative thyroiditis is a surgical incision, drainage of the pus, and antibiotic coverage.
- Antibiotics- Some oral antibiotics used for acute suppurative thyroiditis are Penicillin, Clindamycin, or a combination of Macrolide and Metronidazole. If the patient cannot swallow the tablet, antibiotics can be given via IV (intravenous) if the infection spreads fast. If the patient is resistant to these antibiotics, other more potent antibiotics can be used.
- Surgical Procedures- Percutaneous drainage is a procedure that can be done to remove the pus formation along with antibiotic coverage. And in some rare cases, surgical removal of a specific part of the thyroid gland can be done to treat the infection.
Conclusion:
This type of thyroid infection is very rare and, if found, can be easily treated. A patient can rapidly recover by diagnosing this problem early and stopping the infection from spreading. A patient suffering from this disease can expect a fast recovery, but there is still a chance of recurrence if the infection has spread further in the body.
