Infectious thyroiditis

Q: Pain in acute infectious thyroiditis is usually? (select one) 

A) localized in neck 

B) generalized over neck

Answer: A

Infectious thyroiditis usually occurs in immunocompromised patients. It can occur due to bacteremia or due to local extension. Abscess formation is common and requires urgent attention. Clinically it presents as sudden unilateral neck tenderness. Fever and chills are universal. Unilateral fluctuant neck mass should be considered as an abscess unless proved otherwise. Interestingly though signs of thyrotoxicosis may be present but thyroid function usually stays normal. 

Workup requires an ultrasound and fine-needle aspiration biopsy. Treatment is drainage of abscess and broad spectrum antibiotic.

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References:

1. Paes JE, Burman KD, Cohen J, et al. Acute bacterial suppurative thyroiditis: a clinical review and expert opinion. Thyroid 2010; 20:247. 

2. Shah SS, Baum SG. Diagnosis and Management of Infectious Thyroiditis. Curr Infect Dis Rep. 2000 Apr;2(2):147-153. doi: 10.1007/s11908-000-0027-7. PMID: 11095850. 

3. McLaughlin SA, Smith SL, Meek SE. Acute suppurative thyroiditis caused by Pasteurella multocida and associated with thyrotoxicosis. Thyroid 2006; 16:307.