Thyroid abscess in a 14-month-old child

Suppurative thyroiditis occurring in childhood is rare. Progression to abscess formation is an even more uncommon occurrence. Only four thyroid abscesses occurring in children under 15 yr of age have been reported in the past 20 yr.^1–4A 14-mo-old white girl developed an enlarging mass in the anterior neck. Two weeks previously she was treated for otitis media by her local physician and subsequently was observed to develop a mass in the area of the thyroid gland. Her febrile course was not altered by antibiotics. Physical examination was entirely within normal limits except for the thyroid which was firm and hard with a 4-cm movable mass in the region of the left lobe of the thyroid. There was no associated erythema or apparent tenderness.Laboratory studies included a hemoglogin of 11.6 g/100 ml, hematocrit of 33.5 vol %, white blood cell count of 16,700/ml³ with a differential count of 65 neutrophils, 30 lymphocytes, and 5 monocytes. A urinalysis revealed no abnormalities. Stool culture grew normal enteric flora. A throat culture grew non-Group A beta hemolytic streptococci. A chest film revealed no abnormalities. Studies of thyroid function included a T-3 (30.4%) within normal limits and a T-4 (10.1 μg) in the high euthyroid range.The child received erythromycin 125 mg orally at 6-hr intervals without cessation of fever for 4 days. At this time, it was felt that the fever was related to the thyroid mass which appeared unchanged from the time of admission.At operation, an abscess cavity was noted in the superion of the left lobe of the thyroid gland. Approximately 10 cc of purulent material was removed from the cavity and a Penrose drain was placed in the abscess cavity. A biopsy specimen revealed inflammation and fibrosis consistent with the wall of the abscess. Bacterial, fungal, and acid-fast cultures of the pus were negative.The child became afebrile within 24 hr after operation. The postoperative course was uncomplicated except for the occurrence of a skin abscess at the site of the operative incision. Drainage of this abscess yielded 4 cc of purulent material from which staphylococcus epidermidis was grown. Subsequently the child has not experienced any further difficulty and remains euthyroid.