acute suppurative thyroiditis
Introduction
Introduction to acute suppurative thyroiditis Acute suppurative thyroiditis (AST) is a thyroid purulent inflammation caused by Staphylococcus aureus, and is often secondary to bacterial infections in the mouth, neck, etc. In 1857, Bauchet first described AST. In the absence of antibiotics, the incidence of AST accounts for 0.1% of thyroid surgical diseases. With the application of antibiotics, AST has been rare, and its incidence has not been clearly reported. basic knowledge Sickness ratio: 0.5% Susceptible people: no special people Mode of infection: non-infectious Complications: abscess hypothyroidism edema thrombosis pneumonia pericarditis
Cause
Causes of acute suppurative thyroiditis
(1) Causes of the disease
The common pathogens of acute suppurative thyroiditis are Staphylococcus aureus, hemolytic streptococcus, Streptococcus pneumoniae, Gram-negative bacteria, etc. Bacteria can enter the thyroid gland through the bloodstream, lymphatic tract, adjacent tissue and organ infection spread or puncture operation, most cases Secondary to the upper respiratory tract, direct spread of suppurative infection of the soft tissue of the mouth or neck, such as acute pharyngitis, suppurative tonsillitis, etc., a small number of cases secondary to sepsis or open neck trauma, malnourished infants, diabetic patients, Debilitated elderly or immunodeficiency patients are prone to develop, and pear-shaped fossa is the main cause of acute thyroiditis in children. Walfish et al reported a case of cancerous esophageal-thyroid gland with thyroid aerobic and anaerobic mixed infection. Inflammation, viral infection is very rare, but there have been reports of thyroid cytomegalovirus infection in several AIDS patients.
(two) pathogenesis
Usually, acute inflammatory lesions of the thyroid gland are caused by direct invasion of nearby infected tissues, and can also be transmitted from distant sites. It is also seen in the lymphatic pathway, direct trauma and inflammation through the residual thyroid tongue. Because the piriform crypt is susceptible to infection and then spreads to the thyroid, conversely, tuberculosis or syphilis infections and fungal infections typically cause a relatively chronic, painless process.
Thyroid infections in AIDS patients can be caused by Pneumocystis carinii. In addition, in patients with diffuse coccidioidomycosis, the immune function of the patient is inhibited, and thyroiditis can be caused by infection with Coccidioides, indicating HIV and other diseases. People with reduced immunity may be susceptible to various thyroid infections caused by rare conditions.
1. The naked eye
The thyroid gland is diffuse or localized, such as normal thyroid before the onset, mostly diffuse; such as the original thyroid adenoma or nodules, it is mostly limited, occasionally abscess formation.
2. Microscopic examination
The histological changes of typical acute thyroiditis are massive neutrophil infiltration and tissue necrosis in the thyroid gland, which is characterized by acute suppurative or non-suppurative inflammation, common microabscess formation of suppurative inflammation; thyroid follicular destruction, vasodilation Congestion, sometimes bacterial colonies are visible.
Prevention
Acute suppurative thyroiditis prevention
In order to prevent the recurrence of acute inflammation, attention to sore throat, tonsil enlargement, once it occurs, immediately apply antibiotics to control infection early.
Complication
Acute suppurative thyroiditis complications Complications abscess hypothyroidism edema thrombosis pneumonia pericarditis
Complications of acute suppurative thyroiditis are rare, mainly due to thyroid dysfunction, oppression of abscesses, or local or systemic spread of infection.
Thyroid dysfunction
Due to the destruction of the gland, temporary hypothyroidism and mucinous edema may occur in the clinic.
2. Abscess compression symptoms
Thyroid abscess compresses nerves and trachea, and vocal cord paralysis, tracheal obstruction, and local sympathetic dysfunction may occur.
3. Local spread of infection
Thyroid abscess ruptures to the surrounding tissues and organs (such as the anterior mediastinum, trachea and esophagus) to penetrate and spread, which can lead to internal jugular vein thrombosis and tracheal perforation.
4. Whole body spread
Infection through the blood system spread, patients can be pneumonia, mediastinal inflammation, pericarditis, sepsis, etc., if delayed treatment can often lead to death.
Symptom
Acute suppurative thyroid symptoms common symptoms chills dysphagia cold nodules abscess nodules head and neck activity restricted neck thick
Because the thyroid blood supply is extremely rich, the lymphatic reflux is good, there is a complete capsule, and the iodine concentration in the thyroid tissue is high, so its anti-infective ability is strong, so the incidence of infection to form thyroiditis is not high, and patients with acute suppurative thyroiditis Performance may have chills, fever; peripheral blood granulocytes increased; thyroid local redness, diffuse or localized swelling, sometimes accompanied by ear, mandibular or head occipital radiation pain, early skin in the neck area is not obvious, touch Significant pain, limited neck activity, may have hoarseness, poor breathing or difficulty swallowing, "throat pain" when the head is reclining or swallowing, severe cases can form abscess, but the sense of fluctuation is not obvious.
Inflammation can involve the unilateral thyroid or bilateral thyroid gland, and some are limited to the isthmus. In the later stage of inflammation, local abscess can be expressed and fluctuations occur. In a few cases, pulsatile mass can occur. In recurrent AST, 80% is due to persistence. Piriform sinus-thyroid gland, 92% of which occurs in the left lobe of the thyroid gland, 6% in the right lobe, and 2% in the bilateral thyroid gland.
Clinical manifestation
Symptoms of systemic poisoning; local redness and swelling of the thyroid, diffuse or localized swelling, accompanied by pain in the ear, mandible or head occipital; may have snoring, poor breathing or difficulty swallowing, nerves, trachea, esophageal compression symptoms, physical examination : The local thyroid gland is markedly painful, and the neck activity is limited; when the abscess is formed, there may be a slight fluctuation in the local area.
2. Auxiliary inspection
Thyroid function is basically normal; blood examination indicates infection of the lesion; thyroid imaging examination, suggesting the possibility of local abscess formation; thyroid scan can find cold nodules or cold nodules.
Examine
Examination of acute suppurative thyroiditis
Blood routine
Peripheral blood white blood cell counts and elevated neutrophils.
2. Erythrocyte sedimentation rate is accelerated.
3. C-reactive protein is increased.
4. Functional examination of the thyroid gland
In AST patients with bacterial infection, the function of thyroid is normal, but in cases of fungal infection, thyroid function is mostly low, while patients infected with mycobacteria tend to have hyperthyroidism.
5. Bacteriology examination
The neck puncture aspirate the pus for bacterial culture, and Gram stain helps determine the infected bacteria.
6. Thyroid scan
More than 90% of bacterial infection patients and 78% of mycobacterial infections can be found in cold nodules or cold nodules.
7.B Ultra
A single thyroid swelling or abscess formation can be found.
8. X-ray inspection
You can understand the tracheal deviation or pressure, and sometimes the free gas produced by the gas-producing bacteria in the thyroid and surrounding tissues of the thyroid gland can be found.
9. CT or MRI examination
A mediastinal abscess can be found.
Diagnosis
Diagnosis and diagnosis of acute suppurative thyroiditis
Subacute thyroiditis
It is difficult to identify in the early stage, gradual or sudden painful swelling of the thyroid gland, often history of viral infection, fever, erythema and heat on the surface of severe cases, mild to moderate goiter (often asymmetrical), no invasion of adjacent tissues, Thyroid gland is markedly tender, erythrocyte sedimentation rate is accelerated in the acute phase, thyroid function is elevated, iodine absorption rate is reduced, thyrotoxicosis is manifested, white blood cell elevation is uncommon, aspirin often relieves symptoms, steroid hormones are better, often self-limiting. It lasts for several weeks to several months and does not require surgical treatment. It may have temporary hypothyroidism, fever, increased white blood cells, left nucleus shift, and normal thyroid function suggesting the diagnosis of acute thyroiditis. The application of ultrasound and CT may help to detect abscess early. Clear diagnosis.
2. Acute infectious diseases
Acute suppurative lymphadenitis, infective thyroglossal or cleft palate cyst, laryngeal cartilage, anterior neck cellulitis or abscess, Ludwig angina (purulent submandibular gland inflammation), posterior pharyngeal abscess, thyroid cartilage Membrane inflammation.
3. Malignant tumor
Rapidly growing undifferentiated thyroid cancer has similar clinical manifestations as AST, pain in the anterior cervical region, tenderness, fever, difficulty breathing, older age at diagnosis, involvement of the right thyroid gland, large lesion range, anemia, no thyroid puncture Bacterial culture, antibiotics can not improve symptoms should be suspected of malignant tumors, thyroid biopsy histological examination can confirm the diagnosis, metastatic cancer, undifferentiated thyroid cancer and esophageal cancer due to tumor necrosis or fistula to the thyroid site, laryngeal cancer with cartilage invasion can be similar AST's performance.
4. Thyroid adenoma, cyst or thyroid cancer acute bleeding.
