II. Definition

  1. Painful Thyroiditis associated with Non-Viral Infection

III. Epidemiology

  1. Rare form of Painful Thyroiditis

V. Risk Factors

  1. Immunocompromised patients
  2. Elderly
  3. Pre-existing Thyroid disease in up to 50%
  4. Congenital defect
    1. Persistent thyroglossal duct
    2. Piriform sinus fistula

VI. Symptoms

  1. Acute unilateral Neck Pain and swelling
  2. Symptoms provoked by neck extension
  3. Focal neck structure compression
    1. Dysphagia
    2. Dysphonia
    3. Stridor

VII. Signs

  1. High fever
  2. Erythematous skin overlying Thyroid
  3. Thyroid swollen and tender to palpation (focal or diffusely)
  4. Cervical Lymphadenopathy

VIII. Labs

  1. Complete Blood Count
    1. Leukocytosis with band forms
  2. Blood Cultures
  3. Comprehensive Metabolic Panel
  4. Thyroid Function Tests (TSH, Free T4)
    1. Variable abnormalities or may be euthyroid
    2. Patients return to euthyroid state after infection resolves
    3. Thyroid autoantibodies (if obtained) are absent
  5. C-Reactive Protein (C-RP) or Erythrocyte Sedimentation Rate (ESR) increased

IX. Diagnosis

  1. Thyroid Fine Needle Aspirate (Thyroid FNA)
    1. Indicated for mass, abscess or fluid collection
    2. Ultrasound guided
    3. Send for Gram Stain and culture

X. Imaging

  1. First-Line
    1. CT Neck with contrast (consider including CT Chest)
  2. Alternative studies
    1. MRI Neck
    2. Lateral Neck Xray (may demonstrate soft tissue gas)

XI. Management

  1. Hospitalization
  2. ABC Management (airway management as needed)
  3. Surgery Consultation if abscess drainage required
  4. Intravenous antibiotics to cover suspected organisms
    1. Piperacillin/Tazobactam (Zosyn) 3.375 g IV every 6 hours or 4.5 g IV every 8 hours OR
    2. Meropenem 1 g IV every 8 hours
    3. ADD Vancomycin if MRSA suspected
    4. MODIFY antibiotic therapy based on Gram Stain and culture

XII. Complications

  1. Septic Shock
  2. Airway obstruction
  3. Thyroid abscess
    1. Consider for fluctuant swelling
  4. Vocal Cord Paralysis
  5. Transient Hypothyroidism
    1. Destructive Thyroiditis may result in chronic hypothryoidism

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Related Studies

Ontology: Thyroiditis, Suppurative (C0040150)

Definition (MSH) Acute inflammatory disease of the THYROID GLAND due to infections by BACTERIA; FUNGI; or other microorganisms. Symptoms include tender swelling, FEVER, and often with LEUKOCYTOSIS.
Concepts Disease or Syndrome (T047)
MSH D013969
ICD10 E06.0
SnomedCT 25476006, 3511005
English Infectious Thyroiditides, Infectious Thyroiditis, Suppurative Thyroiditides, Suppurative Thyroiditis, Thyroiditides, Infectious, Thyroiditides, Suppurative, Thyroiditis, Infectious, THYROIDITIS ACUTE PYOGENIC, INFECT THYROIDITIS, THYROIDITIS INFECT, Suppurative thyroiditis, Thyroiditis, Suppurative [Disease/Finding], acute suppurative thyroiditis, Thyroiditis, Suppurative, thyroiditis infectious, Infectious thyroiditis (diagnosis), Acute suppurative thyroiditis, Acute suppurative thyroiditis (disorder), Infectious thyroiditis (disorder), Infectious thyroiditis, suppurative; thyroiditis, thyroiditis; suppurative, Infectious thyroiditis, NOS, Infectious Thyroiditides, Acute, Infectious Thyroiditis, Acute, Suppurative Thyroiditides, Acute, Suppurative Thyroiditis, Acute, Thyroiditides, Acute Infectious, Thyroiditides, Acute Suppurative, Thyroiditis, Acute Infectious, Thyroiditis, Acute Suppurative, Acute Infectious Thyroiditides, Acute Infectious Thyroiditis, Acute Suppurative Thyroiditides, Acute Suppurative Thyroiditis
French Thyroïdite aigüe infectieuse, Thyroïdite aiguë infectieuse, Thyroïdite aigüe d'origine infectieuse, Thyroïdite suppurée, Thyroïdite infectieuse, Thyroïdite aiguë d'origine infectieuse
Swedish Tyreoidit, varbildande
Czech tyreoiditida hnisavá, Infekční thyroiditida
Finnish Märkivä kilpirauhastulehdus
Italian Tiroidite infettiva, Tiroidite acuta infettiva, Tiroidite suppurativa acuta, Tiroidite suppurativa
Polish Zapalenie tarczycy ropne
Japanese 化膿性甲状腺炎, 甲状腺炎-化膿性, カンセンセイコウジョウセンエン, 感染性甲状腺炎, 甲状腺炎-感染性
Spanish Tiroiditis infecciosa, tiroiditis infecciosa (trastorno), tiroiditis infecciosa, tiroiditis supurativa aguda (trastorno), tiroiditis supurativa aguda, Tiroiditis Infecciosa, Tiroiditis Supurativa
Portuguese Tiroidite infecciosa, Tireoidite Infecciosa, Tireoidite Supurativa
Dutch infectieuze thyreoïditis, etterig; thyroïditis, thyroïditis; etterig, Suppuratieve thyreoiditis, Thyreoiditis, infectieuze, Thyreoiditis, suppuratieve
German Infektioese Schilddruesenentzuendung, Thyreoiditis, eitrige, Thyreoiditis, infektiöse
Hungarian Fertőző thyroiditis
Norwegian Akutt suppurativ tyreoiditt, Suppurativ tyreoiditt, Infeksiøs tyreoiditt, Akutt infeksiøs tyreoiditt