Cervical thymic cyst as a cause of acute suppurative thyroiditis

A case of acute suppurative thyroiditis following a perithyroidal abscess, which was thought to have resulted from infection of a cervical thymic cyst, is reported herein. The patient was an 8 year old asthmatic Japanese boy who originally presented with tender swelling of the left anterior neck in July, 1986. Although pharyngography could not clearly demonstrate the pyriform sinus fistula, a hypoechoic area around the left lobe of the thyroid gland was noted on ultrasonography. Incisional drainage revealed Streptococcus milleri. A diagnosis of acute suppurative thyroiditis was established, and a cystic tubular mass was surgically resected from the left perithyroidal space some time later. Histopathological examination of the specimen revealed partly cystic thymic tissue along with parathyroid tissue. These observations suggested that acute suppurative thyroiditis in this case was caused by a perithyroidal abscess and that a perithyroidal abscess may also result from infection of a cervical thymic cyst.     

Suppurative thyroiditis with gas formation

Acute suppurative thyroiditis with gas formation is very rare. A 70-year-old woman was admitted with dysphagia and fever. The clinical diagnosis of acute thyroiditis was supported by fine needle aspiration biopsy. X-ray examination showed gas collection within the soft tissue of the anterior neck and ultrasonography of the thyroid gland showed a cavity filled with thick liquid. The patient was treated with antibiotic therapy followed by thyroidectomy.     

Thyrotoxicosis and thyroiditis

Thyrotoxicosis is the clinical syndrome of excess circulating thyroid hormones and is most commonly caused by conditions in which excessive thyroid hormone synthesis (hyperthyroidism) occurs such as Graves' disease, toxic multinodular goitre and solitary toxic nodule. Thyrotoxicosis may also be due to release of stored thyroid hormones, without an increase in synthesis, which occurs in thyroiditis. The aetiology, pathogenesis, diagnosis, investigation and management of conditions causing thyrotoxicosis and thyroiditis are reviewed in this chapter. Rare causes of thyrotoxicosis are briefly described.     

415例结节型桥本氏甲状腺炎的诊断和外科治疗的经验和教训

【摘要】 目的 探讨结节型桥本氏甲状腺炎的诊断、手术适应证及术式选择。方法〓资料来源于2005年1月至2014年1月在我院接受诊治的415例桥本氏甲状腺炎的完整病案病例。诊断方法通过检测甲状腺抗体;超声、CT查、同位素扫描;细针或粗针穿刺活检联合检查。所有患者均表现为甲状腺结节而进行手术治疗,根据患者结节的病变范围,主要采取甲状腺全切、患侧腺叶+峡部切除及双侧腺叶次全切除术进行治疗。结果〓415例中:单纯桥本氏甲状腺炎157例,桥本氏甲状腺炎合并毒性甲状腺肿18例,合并结节性甲状腺肿146例,合并甲状腺腺瘤31例,合并甲状腺癌63例。结论〓桥本氏甲状腺炎临床表现缺乏特异性,应采用采取多种检查手段提高诊断的准确性,避免手术不必要手术,但疑有恶变或产生压迫症状者应积极手术。以往诊断出现结节即采取手术的方法不符合当前治疗指南。     

Surgical intervention in chronic (Hashimoto's) thyroiditis.

The incidence of chronic (Hashimoto's) thyroiditis in surgical specimens is relatively high, i.e., 13% in collected studies, for a disease with clinical and laboratory characteristics that are sufficiently specific, that thyroidectomy should rarely be required for diagnosis or treatment. This incidence is presumably related to the difficulty in distinguishing between thyroiditis and a thyroid neoplasm. Experience with 260 thyroidectomies at the North Carolina Memorial Hospital performed between 1875 and 1980 for a dominant thyroid mass was reviewed to determine the reliability of criteria for diagnosis and the indications for surgical treatment. Using the criteria of clinical findings, complemented by laboratory studies, e.g., free thyroxine index, thyroid autoantibodies, TSH level, thyroid scan, in addition to the judicious use of the cutting (core) needle biopsy procedure, the incidence of Hashimoto's thyroiditis in this series was 3% and cancer-27%. Four patients had Hashimoto's thyroiditis coincidental to another disease for which thyroidectomy was performed. In seven patients Hashimoto's thyroiditis alone constituted the indications for operation. The indications for operation in these patients were: autonomous function with mild hyperthyroidism (2 patients); associated cold nodule (2 patients); thyromegaly unresponsive to suppressive therapy (2 patients); and rapidly enlarging mass simulating a neoplasm (1 patient). Only one of 71 patients with well differentiated carcinoma had Hashimoto's thyroiditis. One patient with Hashimoto's thyroiditis had associated lymphoma. In most patients, Hashimoto's thyroiditis can be identified using appropriate clinical and laboratory criteria without resorting to thyroidectomy to differentiate between thyroiditis and a neoplasm. Operations are indicated in patients with suspected or established chronic thyroiditis for: 1) the presence of a dominant mass with incomplete regression on suppressive therapy. 2) Progression of thyromegaly despite suppressive therapy. 3) Historic or physical findings suggest a malignancy, e.g., irradiation, multiple endocrine adenomatosis (MEA) syndrome, nerve paralysis, pain, tracheal compression, stipple calcification and cervical lymph node enlargement. 4) Indeterminant findings on cutting needle biopsy, e.g., lymphoma versus thyroiditis. Rarely, an operation is required for an oppressive goiter or associated hyperthyroidism.     

Thyrotoxicosis and thyroiditis

Thyrotoxicosis is a common presentation of thyroid disease. The commonest cause is Graves’ disease. The clinical features including goitre, eye disease, causes and diagnosis of thyrotoxicosis are discussed. Treatment strategies of Graves’ disease include anti-thyroid drugs, radioiodine and thyroidectomy. It is important to adequately prepare patients prior to surgery to reduce the possibility of thyroid storm. The preferred surgical procedure today is a total thyroidectomy, although historically subtotal thyroidectomy was performed. Less common but relevant surgical causes of thyrotoxicosis are also discussed.Thyroiditis (thyroid inflammation) has a variety of causes. Hashimoto's thyroiditis may present with a transient thyrotoxicosis or long term hypothyroidism. Surgery is rarely required. Subacute thyroiditis thought to be secondary to a viral infection can cause a short-term yet marked thyrotoxicosis due to thyroid damage. Other causes such as amiodarone-induced thyrotoxicosis can be more difficult to manage due to the underlying heart disease and may require thyroidectomy.     

Thyrotoxicosis secondary to acute suppurative thyroiditis induced by a chicken bone

Acute bacterial thyroiditis is uncommon. Recently we had encountered a case of retropharyngeal abscess following chicken bone ingestion and complicated by thyrotoxicosis due to acute infective thyroiditis. We believed this is the first reported case of thyrotoxicosis induced by foreign body impacted at the upper digestive tract.      

Acute suppurative thyroiditis caused by Eikenella corrodens

Eikenella corrodens is a slow-growing facultative anaerobe present in the normal oral flora. Two children have been described with acute suppurative thyroiditis with E corrodens as the major pathogen. Staphylococci are the most frequently identified pathogens in acute suppurative thyroiditis. Penicillin or ampicillin are the drugs of choice for infections caused by E corrodens. Anatomic defects should be searched for in children with acute suppurative thyroiditis.     

Riedel甲状腺炎的临床与影像学表现

目的 探讨Riedel甲状腺炎(RT)的临床与影像学特点.方法 对13例RT患者行超声、CT平扫、CT增强及MR平扫检查,分析其影像学特点.结果 超声表现为甲状腺局限性肿大伴不均质低回声结节11例,肿块与周围组织分界不清12例,无钙化、彩色血流患者.CT平扫表现为甲状腺内等、略高密度结节灶11例,密度均匀减低的弥漫性甲状腺肿大2例.CT增强示甲状腺结节强化程度弱于周围正常甲状腺组织.MR平扫示甲状腺呈T1WI、T2WI低信号的结节样肿大.结论 RT临床常表现为质硬的无痛性肿块,易累及周围组织引起相应的临床症状.RT影像学表现尤其是MRI特点较典型,有助于RT的诊断.     

Thyrotoxicosis and thyroiditis

Thyrotoxicosis is a common condition resulting from excess of circulating thyroid hormones in the blood. The most frequent cause of thyrotoxicosis is Graves' disease and the clinical features include goitre and eye disease. The treatment strategies in Graves’ disease involve anti-thyroid drugs, radioiodine and thyroidectomy. Thyroiditis (inflammation of the thyroid) is caused by release of stored thyroid hormones and may also result in thyrotoxicosis. The aetiology, pathogenesis, diagnosis, investigation and management of conditions causing thyrotoxicosis and thyroiditis are reviewed in this chapter. Rare causes of thyrotoxicosis are highlighted.     

Thyroid cancer with coexistent Hashimoto's thyroiditis. Clinical assessment and management

Hashimoto's thyroiditis is a common thyroid disorder. Because of the difficulty of diagnosing a coexisting thyroid cancer, its management remains controversial. We reviewed 120 cases of thyroid cancer seen in our institution during an 11-year period (1976 through 1986) and defined the clinical characteristics of patients with both entities. Thirteen patients had concomitant cancer and Hashimoto's thyroiditis. Six of the 13 patients had a history of thyroiditis before the diagnosis of thyroid cancer. The remaining seven patients had evidence of Hashimoto's thyroiditis on histologic review of the thyroid specimen. The two most common characteristics prompting surgical intervention were the presence of a nonsuppressing dominant nodule and a cold area on thyroid scan. Twelve patients underwent preoperative fine-needle aspiration cytologic examination, but only in three were the results considered to be indicative of cancer. All 13 patients remained disease free. Despite the apparent indolence of thyroid cancer associated with Hashimoto's thyroiditis, selective surgical treatment of patients with clinical thyroiditis is indicated.     

Surgical treatment of Hashimoto's thyroiditis. Personal experience

BACKGROUND: To report personal experience in the surgical treatment of Hashimoto's thyroiditis. METHODS. Eight patients (7 females, 1 male, mean age 48 years old) referred to our Institution with diagnosis of Hashimoto's thyroiditis have been studied. All patients were evaluated by determination of serum thyroid hormones and of anti-thyreoglobulin and anti-microsomal antibodies; ultrasound and scintigraphic scans of the gland were performed in all cases and a cytological examination of fine needle aspiration (FNAC) of the nodules was evaluated. Diagnosis of Hashimoto's thyroiditis was suspected on the basis of clinical and laboratory data and was confirmed by cytology and histology on surgical specimens. Preoperative FNAC showed a Hashimoto's thyroiditis with thyroid differentiated carcinoma in 3 cases (37.5%), Hashimoto's thyroiditis in 1 case and chronic thyroiditis in 4 cases (50%). Seven patients underwent surgery, while 1 patient received a medical treatment; we performed 6 total thyroidectomies and 1 hemithyroidectomy. Histology on surgical specimens confirmed the diagnosis of Hashimoto's thyroiditis in all cases; in 3 patients an associated papillary thyroid carcinoma was found. RESULTS: Postoperative mortality was absent; no major postoperative complications (laryngeal nerve paralysis or permanent hypocalcemia) were recorded. Only 2 mild transient hypocalcemias have been observed. CONCLUSIONS: Total thyroidectomy is the technique of choice in surgical treatment of Hashimoto's thyroiditis, a self-immune pathology which involves the whole gland and has a high correlation with differentiated thyroid carcinoma (37.5%). Total thyroidectomy warrants a radical and definitive control of the disease, without risk of relapse, with a low incidence of major complications, in experienced hands, and anyway lower than the morbility due to reinterventions.     

Acute thyroiditis

Acute suppurating thyroiditis is now an uncommon pathology which is rarely found, although it was frequent before the introduction of antibiotics. Having observed a case, the Authors were prompted to study the subject in greater depth, in particular to assess whether the disease is easier to diagnose using modern techniques diagnosis, and whether there are changes in the therapy. In conclusion, the paper affirms that in spite of the fact that the diagnostic evolution has thrown further light on the clinical aspects of the disease, biopsy still remains the most reliable instrument of diagnosis, whereas surgery is the most effective form of therapy.     

Thyrotoxicosis and thyroiditis

Thyrotoxicosis is a common condition resulting from excess of circulating thyroid hormones in the blood. The most frequent cause of thyrotoxicosis is Graves' disease and the clinical features include goitre and eye disease. The treatment strategies of Graves' disease involve anti-thyroid drugs, radioiodine and thyroidectomy. Thyroiditis (inflammation of the thyroid) is caused by release of stored thyroid hormones and may also result in thyrotoxicosis. The aetiology, pathogenesis, diagnosis, investigation and management of conditions causing thyrotoxicosis and thyroiditis are reviewed in this article. Rare causes of thyrotoxicosis are highlighted.     

桥本病及其共存病的诊断和处理

目的 探讨桥本病及与其共存病的诊断和外科处理原则。方法 回顾性分析５４例桥本病患者的临床资料。结果 甲组２５例经临床检查、小针穿刺细胞学检查及免疫抗体测定拟诊桥本病,采用药物诊断性治疗,２４例治愈,１例后发现共存癌中转手术;乙组２９例因非典型表现误诊为外科病施行甲状腺切除术,术后均经病理切片明确诊断,并发现１４例与甲状腺其它良、恶性疾病共存（甲亢３例,甲状腺癌４例,恶性淋巴瘤２例,甲状腺腺瘤５例）     

甲状腺炎合并甲状腺癌210例诊治分析

目的 探讨甲状腺炎合并甲状腺癌的临床特点,以利早期诊治。 方法 收集2008年6月至2009年12月吉林大学中日联谊医院甲状腺外科手术治疗甲状腺炎合并甲状腺癌的临床资料,对其进行分析总结。结果 甲状腺炎合并甲状腺癌共210例,占同期甲状腺癌手术病人的26.0%（210/807）,占同期确诊甲状腺炎病人的41.0%（210/512）。术前超声显示边界欠清的限局性低回声区、弥漫性低回声、强回声区和合并钙化者,所占比例分别为89.1%（187/210）、7.6%(16/210)、3.3%（7/210）、46.7%（98/210）;210例均行甲状腺癌根治术,其中164例同时行颈部淋巴结清扫术,淋巴结转移率为50.6%（83/164）。结论 甲状腺炎合并甲状腺癌的比例较高,对超声显示伴边界欠清、限局性低回声区并有颈部淋巴结肿大的病人,应密切观察病情变化,积极行穿刺组织学检查或手术治疗。     

Thyroid disorders. Part II: hypothyroidism and thyroiditis.

Part II of the series on thyroid disorders discusses hypothyroidism and thyroiditis that may be found in dental patients. An overview of the conditions is presented. Presenting signs and symptoms, laboratory tests used to diagnose hypothyroidism and thyroiditis, and their medical management is discussed. The dental management of patients with hypothyroidism is discussed in detail. The dentist by detecting the early signs and symptoms of hypothyroidism and thyroiditis can refer the patient for medical diagnosis and treatment and avoid potential complications of treating patients with uncontrolled disease. Patients with thyroiditis may have a short period of being hyperthyroid and it may be best to avoid routine dental treatment during that period. Patients with suppurative thyroiditis should not receive routine dental treatment during the acute stage of the disease. The end stage of Hashimoto's thyroiditis results in hypothyroidism. Central nervous system depressants, sedatives, or narcotic analgesics must be avoided in patients with severe hypothyroidism because significant respiratory depression may occur. In addition, myxedematous coma, particularly in elderly hypothyroid patients, can be precipitated by central nervous system depressants, infection, and possibly stressful dental procedures. In medically well-controlled patients the dental treatment plan is not affected and most dental procedures can be offered to these patients.     

The incidence of thyroid carcinoma in Hashimoto's thyroiditis

The incidence of thyroid carcinoma in Hashimoto's thyroiditis has been a widely debated issue. Previous authors have reported on this topic by analyzing series of patients with Hashimoto's thyroiditis or patients with thyroid carcinoma, but not both of those populations in the same series. The population consists of a consecutive series of 800 patients operated on for thyroid nodules not associated with a radiation history. Among 161 patients with the diagnosis of thyroid carcinoma, 61 (38%) had coexistent Hashimoto's thyroiditis. In comparison, among 161 sex- and age-matched patients with colloid nodules in the same population, 18 (11%) had Hashimoto's thyroiditis. Furthermore, in the series as a whole, the incidence of Hashimoto's thyroiditis in 423 patients with colloid nodules was 10 per cent. From the perspective of the Hashimoto's thyroiditis population in the same series of 800 thyroidectomies, among 267 patients with Hashimoto's thyroiditis 61 (23%) had coexistent carcinoma. In comparison, among 267 age- and sex-matched patients with colloid nodules there were only ten coexistent carcinomas for an incidence of 4 per cent. The high incidence of carcinoma of the thyroid in Hashimoto's thyroiditis lends credence to the hypothesis that Hashimoto's thyroiditis is a predisposing factor in the development of thyroid carcinoma.     

Fine-needle biopsy cytology in autoimmune thyroiditis

Fine-needle biopsy is used in the thyroid pathology especially for the differential diagnosis concerning malignant lesions. From a total of 59 cases of thyroiditis, in 12 was possible to proceed to fine-needle biopsy, in large goiters and nodules larger than 1 cm in diameter; in these cases were obtained smears, stained in May-Grünwald-Giemsa technique. In 9 cases of the 12 investigated, in the smears appeared lymphocytes and macrophages, cells commonly found in the infiltrates of the thyroid gland, in autoimmune thyroiditis, and sometimes also few normal thyrocytes. Fine-needle biopsy is important in the diagnosis algorithm of the thyroid nodules, involving 4, up to 7% of the general population. It has also the advantage of reducing the number of cases solved by surgical therapy, as it is the case with the diagnosis of Hashimoto's thyroiditis.     

IgG4阳性桥本甲状腺炎超声表现

目的探讨IgG4阳性桥本甲状腺炎的超声表现。方法回顾性分析72例经我院手术病理证实为桥本甲状腺炎患者的临床和超声资料。根据免疫组化染色结果分为IgG4阳性组19例、IgG4阴性组53例。比较2组甲状腺的回声类型、合并结节情况、血流分布及甲状腺功能状态。结果 2组间甲状腺内低回声比例、网格样线样高回声比例、合并甲状腺癌比例差异均有统计学意义(P均0.05),2组间伴发结节数量、甲状腺血流分布、甲状腺功能状态差异均无统计学意义(P均0.05)。结论超声可为临床诊断IgG4阳性桥本甲状腺炎提供有价值的影像学依据。