Friday, 29 November 2013

Thyroid Disease : Acute thyroiditis – The Causes and Risk Factors

Thyroid disease is defined as a condition of malfunction of thyroid. Hyperthyroidism is a condition in which the thyroid gland is over active and produces too much thyroid hormones. Hypothyroidism is a condition in which the thyroid gland is under active and produces very little thyroid hormones. Thyroid cancer is defined as condition in which the cells in the thyroid gland have become cancerous.
Acute thyroiditis (Acute infectious thyroiditis or acute suppurative thyroiditis) is defined as a condition of as a result of relatively high amount of iodine in the tissue causes of microbial inflammatory thyroiditis, pyrogenic thyroiditis and bacterial thyroiditis. Acute infectious thyroiditis is very rare, accounting for about 0.1-0.7% of all thyroiditis.
B. Causes and Risk Factors
B.1. Causes
According to the study by the Georgetown University, the most common anaerobic bacteria are Gram-negative bacilli and Peptostreptococcus spp. Agents that are rarely recovered include Klebsiella spp., Haemophilus influenzae, Streptococcus viridans, Salmonella spp., Enterobacteriaceae, Mycobacterium tuberculosis, atypical mycobacteria, Aspergillus spp., Coccidioides immitis, Candida spp., Treponema pallidum, and Echinococcus spp. Viruses have been associated with subacute thyroiditis, and include measles, mumps, influenza, enterovirus Epstein-barr, adenovirus, echovirus, and St Louis encephalitis(7).
There is a report of two cases of bacterial suppurative thyroiditis caused by Streptococcus anginosus(8) . Other report that cute suppurative thyroiditis in a patient with prior subacute thyroiditis(9), and cute suppurative thyroiditis caused by an infected piriform sinus fistula with thyrotoxicosis(10). The Ito Hospital report of a case of Cervical thymic cyst as a cause of acute suppurative thyroiditis(11).
Other rarer pathogens include fungi, parasites(12).
B.2. Risk Factors
1. Immunocompromised patients
People who have weakened immune system are at increased risk of bacterial, virus and fungal causes of cute infectious thyroiditis.
2. Elderly
If you are elder, you are associated with increased of cute infectious thyroiditis.
3. Pre-existing Thyroid diseaseand Elderly
There is a report of a case of suppurative thyroiditis occurring in a 72-year-old woman is reported. The clinical history of this woman, treated by tianeptine for mild exogenous affective disorder and by conventional insulin therapy for long-standing insulin-dependent diabetes, was remarkable for the pseudotumoral signs which led to the simultaneous diagnosis of hypothyroidism due to Hashimoto’s thyroiditis and of mycobacterium avium intracellulare suppurative thyroiditis(13).
4. Congenital defect
4.1. Complete congenital third branchial fistula
There is a report of a nine-year-old boy presented with a history of a small opening in the middle third of the anterior neck since birth, with recurrent surrounding swelling. There was no history of surgical drainage or spontaneous rupture. Computed tomography with contrast injection into the external cervical opening revealed a patent tract from the neck skin to the base of the pyriform sinus. Complete excision of the tract up to the pyriform sinus with left hemithyroidectomy was performed. Follow up at 22 months showed no recurrence(14).
4.2. Fourth branchial arch anomalies
Fourth branchial arch anomalies represent <1% of all branchial anomalies and present as recurrent neck infections or suppurative thyroiditis(14a).
4.1. Persistent thyroglossal duct
There is a report of Thyroid imaging in a typical case of acute suppurative thyroiditis with abscess formation due to infection from a persistent thyroglossal duct(15).
4.2. Piriform sinus fistula
There is a report of an acute suppurative thyroiditis as a result of an infected piriform sinus fistula with thyrotoxicosis(16).
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