Acute purulent thyroiditis.

Acute purulent thyroiditis is caused by coccal flora and is rare. The use of antibiotics to treat coccal infections has made this form of thyroiditis very rare.

However, it should be remembered that after pneumonia, acute tonsillitis, sinusitis or otitis, bacteria can be hematogenously or lymphogenously introduced into the thyroid gland and cause inflammation.

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Pathogenesis

As a rule, inflammation affects a section of a lobe or the entire lobe, and goes through all the stages characteristic of inflammation: proliferation, exudation, alteration.

Pyogenic changes are often local in nature and affect mainly the left lobe (very rarely - the entire gland). Sometimes they spontaneously resolve, sometimes they form abscesses. With suppuration, expansive destruction of the thyroid gland and its capsule is observed. The process spreads along the neck up to the mediastinum.

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Symptoms acute purulent thyroiditis.

Symptoms of acute purulent thyroiditis are characterized by a rapid rise in body temperature to 38-39 °C, pain in the neck area radiating to the ear, upper and lower jaw; the intensity of pain in purulent thyroiditis is extremely pronounced, sometimes the pain is pulsating. The function of the thyroid gland is usually not affected, since the unaffected lobe completely provides the need for thyroid hormones.

Tachycardia, feeling of heat, sweating that patients have are the reaction of the autonomic nervous system to inflammation and temperature rise. Regional lymph nodes may be enlarged and painful. Patients are most concerned about pain that intensifies with movement or swallowing, a feeling of pressure, distension in the thyroid gland, and general malaise. In spontaneous cases, inflammation may end in abscess formation with subsequent opening of the abscess outward or into the mediastinum, which worsens the prognosis. Complications most often include thrombosis of nearby veins.

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Diagnostics acute purulent thyroiditis.

The diagnosis of acute purulent thyroiditis is made on the basis of anamnestic data on the presence of a primary source of infection, rapid increase in temperature and pain, a positive effect from antibiotic treatment, and the absence of symptoms of thyroid dysfunction. In laboratory research methods, changes in the clinical blood test should be emphasized: leukocytosis with a shift in the formula to the left, moderately increased ESR up to 20-25 mm/h.

Scanning of the gland is rarely performed nowadays. Ultrasound reveals a section of the echo-negative zone, in the case of an abscess - with liquid contents and enlarged regional lymph nodes. No immunological disorders are observed in this form of thyroiditis. Additional data can be obtained by aspiration biopsy, which is rarely used (usually after this, antibiotics are instilled directly into the gland through the same needle).

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Differential diagnosis

Acute purulent thyroiditis must be differentiated from subacute de Quervain's thyroiditis, hemorrhage into the thyroid gland, acute non-purulent thyroiditis after radiation therapy. In the second and third cases, the pain is less pronounced, there are no inflammatory changes in the blood; in the latter - a history of radiation therapy (usually treatment with ¹³¹ I).

Treatment acute purulent thyroiditis.

If there is no data on the sensitivity of the pathogen to antibiotics in the primary focus, penicillin should be prescribed at 500,000 IU every 4 hours for 7-10 days. As a rule, during this period, the temperature and clinical blood test indicators return to normal, and pain disappears. It is necessary to prefer the antibiotic to which the pathogen is sensitive.

Prevention

Prevention of acute purulent thyroiditis - timely treatment of primary foci of infection with antibiotics.

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Forecast

Acute purulent thyroiditis has a favorable prognosis. As noted above, the disease does not lead to dysfunction of the thyroid gland, these patients are not subject to medical examination, and working capacity is fully restored after the acute inflammation ends.