A Case Report on Acute Suppurative Thyroiditis

Acute suppurative thyroiditis is a rare endocrine emergency that may be life-threatening. It accounts for 0.1 to 0.7 percent of thyroid pathologies treated surgically. We present a case of a 3-year-11-month-old girl who was brought to the hospital by her parents with a one-week history of painful anterior neck swelling that began as the size of the child’s middle finger’s distal phalanx and progressed to occupying much of the anterior neck. There had been a previous history of fish bone impaction 2 weeks prior while feeding. Within 24 hours of admission, the infant was found to be febrile (temperature 38.5°C), with dysphagia, hoarseness, and restricted head movement. There is no history or clinical signs of hyperthyroidism or hypothyroidism. The lymph nodes in the anterior cervical region were swollen and tender. Her weight was average at 13 kg. Local inspection revealed a 4 cm x 4 cm mass in the anterior neck, more on the left half, no skin changes, and no discharge. Different levels of warmth and tenderness were present. It was erratic and moved when I swallowed. The right lobe of the thyroid gland was standard on ultrasound, but the left thyroid gland was swollen to 4.52 cm x 3.37 cm with a heterogeneous echo texture. TSH 0.3 (0.5-3.7 mIU/L); fT3 0.3 (1.4-4.2 pg/ml); fT4 1.4 (0.8-2.0 pg/ml) were all within the range of euthyroid sick syndrome. A diagnosis of acute suppurative thyroiditis was made, and the patient was given IV antibiotics. Cefuroxime and metronidazole were prescribed, and by the fifth day, a portion of the swelling had turned hyperemic and was exuding pus. The abscess was cut open, and 4 mL of frank pus was drained. Klebsiella was found to be allergic to ciprofloxacin, ofloxacin, and amoxyl-clavulanic acid after microscopy, culture, and sensitivity testing of the aspirate. After that, the child’s health changed dramatically, and she was discharged home and is doing well. As a result, timely diagnosis and care are critical. In all paediatric cases, a pyriform sinus fistula should be assumed.

Author (s) Details

I. O. Oluwayemi
Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria.

F. O. Abduraheem
Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria.

O. T. Agaja
Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria.

O. J. Oke
Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria.

E. O. Ogundare
Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria.

A. B. Ajite
Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria.

O. S. Olatunya
Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria.

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