Acute purulent thyroiditis

Acute purulent thyroiditis is caused by cocco flora, it 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, the bacteria can be hematogenously or lymphogenically introduced into the thyroid gland and cause inflammation.

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Pathogenesis

As a rule, the inflammation captures the portion of the lobe or the whole of the lobe, passes through all the stages characteristic for inflammation: proliferation, exudation, alteration.

Piogennye changes are more often local in nature and affect mainly the left share (very rarely - the whole gland). Sometimes they dissolve spontaneously, sometimes they form abscesses. When suppuration is marked expansive destruction of the thyroid gland and its capsules. The process spreads around the neck right up to the mediastinum.

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Symptoms of the acute purulent thyroiditis

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

The patients with  tachycardia, heat, sweating are the reaction of the autonomic nervous system to inflammation and temperature rise. Regional lymph nodes can be enlarged and painful. Patients are most concerned with pain, which is aggravated by movement or swallowing, a feeling of pressure, raspiraniya in the field of the thyroid gland, a general malaise. In spontaneous flow, inflammation can result in abscess formation followed by opening the abscess outward or in the mediastinum, which worsens the prognosis. Of the complications most often can be a thrombosis of nearby veins.

[12], [13]

Diagnostics of the acute purulent thyroiditis

The diagnosis of acute purulent thyroiditis is based on anamnestic data on the presence of a primary foci of infection, rapid increase in temperature and pain, the positive effect of antibiotic treatment, and the absence of symptoms of thyroid dysfunction. In laboratory methods of research it is necessary to emphasize changes in the clinical analysis of blood: leukocytosis with a shift of the formula to the left, moderately increased ESR to 20-25 mm / h.

Scanning of the gland is currently done rarely. Ultrasound region is determined on ultrasound, in case of abscess - with liquid contents and enlarged regional lymph nodes. Immunological disorders with this form of thyroiditis are not observed. Additional data can be obtained by aspiration biopsy, which is rarely used (usually after this, the same needle is used to instill antibiotics directly into the gland).

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Differential diagnosis

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

Treatment of the acute purulent thyroiditis

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

Prevention

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

[17], [18], [19], [20], [21], [22]

Forecast

Acute purulent thyroiditis has a favorable prognosis. As noted above, the disease does not lead to a violation of the thyroid gland function, these patients are not subject to medical examination, the work capacity is restored completely after the end of acute inflammation.