Friday, 29 November 2013

Thyroid Disease : Acute thyroiditis – The Misdiagnosis

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,
D.1. Misdiagnosis
1. Thyroid cancer
There is a report of a 44-year-old man presented with anterior neck tender swelling and odynophagia for 12 days. He had thyrotoxicosis. He was initially diagnosed as thyroid cancer due to the misleading computed tomography report. Fine needle aspiration (FNA) yielded pus and neutrophils, according to Fudan University(22).
2. Misleading result of fine-needle aspiration biopsy
There is a report of a case of acute thyroiditis in a 6-year-old girl, whose initial borderline clinical and sonographic data, coupled with the absence of leucocytes and bacteria on the fine-needle aspiration biopsy, led to the reversal of the initial diagnostic impression of acute thyroiditis and the institution of an inappropriate glucocorticoid treatment.(23).
3. Juvenile systemic lupus erythematosus
There is a report of an unusual case of acute suppurative thyroiditis associated with juvenile systemic lupus erythematosus (JSLE) onset(24).
4. Hashimoto’s thyroiditis
There is a report of a case of a six-year-old girl who had presented a mass with flogistic signs in the anterior neck region for fifteen days, together with leukocytosis and increased levels of VSH and TSH. There was no evidence of previous thyroid disease and the cervical ultrasonography suggested thyroid abscess. Intravenous antibiotic and surgical drainage were done with a good response, however, the patient developed clinical hypothyroidism afterwards. Barium swallow did not demonstrate pyriform sinus fistula and the follow-up ultrasonography revealed heterogeneous internal texture suggesting Hashimoto’s thyroiditis(25).
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