Acute purulent thyroiditis E06.0

Acute purulent thyroiditis (also called infectious thyroiditis) is a rare disease of the thyroid gland. It accounts for only about 1-3% of all thyroid diseases. On the one hand, this is due to the good blood supply and lymphatic drainage of the gland, but on the other hand it is also due to the high intrathyroid iodine concentration, as this has a bactericidal effect.

The most common pathogens are gram-positive bacteria (Streptococcus pyogenes, Streptococcus pneumoniae, Staphylococcus aureus; but also Escherichia coli, mycobacteria and even anaerobes are possible). Pathogens, starting from bacterial infections in the head and neck area, enter the thyroid tissue haematogenically or lymphogenically.

Acute thyroiditis occasionally occurs in close temporal relation to viral infections, e.g. in diseases caused by herpes, measles, mumps, influenza, adeno- or echo viruses. However, a direct connection with the viral infection has not been proven up to now, since it has not been possible to detect viruses or inclusion bodies in the thyroid tissue.

Typical is a sudden onset of the disease with severe pain in the neck area. There is a localized mass in the thyroid gland, partly circumscribed, partly diffusely fluctuating. The tissue above the mass is in most cases swollen, overheated and reddened. There are also general symptoms such as fever (not obligatory!), sweating, tachycardia and a severe feeling of illness. In addition, patients complain of difficulty swallowing, hoarseness and pain radiating into the neck, ear region or lower jaw. The cervical lymph nodes are usually swollen.

Sonography shows an inhomogeneous pattern overall. There are both low-echo and echo rich areas. In the case of abscessing: low-echo areas.

Thyroid scintigraphy is rarely indicated (unclear diagnosis, complications etc.). In this case, a memory defect (cold area) in the affected tissue area is typically seen.

Inflammation markers are almost always elevated: (BSG, leucocytes and C-reactive protein), with thyroid levels mostly in the euthyroid range. However, minor changes in TSH, fT3 and fT4 are also possible.

Non-purulent thyroiditis (e.g. radiation thyroiditis, subacute granulomatous thyroiditis de Quervain)

Therapy should be carried out immediately after fine needle puncture to avoid serious complications (such as sepsis or inflammation of the mediastinum) as far as possible.

Cooling pads in the form of an ice tie can bring acute relief, as can anti-inflammatory drugs.

Once the pathogen has been identified, antibiotics are given in high doses and intravenously, according to the resistance test. Surgical intervention (incision and drainage) may also be necessary, but since the metabolic state is usually euthyroid throughout the entire disease process, hormone replacement will only rarely be necessary.

The biopsy for pathogen detection is the most important criterion. It serves both for diagnostics and therapy.

1. Heufelder AE et al. (1998) Thyroiditis: Current status of pathogenesis, diagnostics and therapy. Dtsch Arztebl 95: A-466 / B-394 / C-368.