Bacterial infection of the thyroid gland (acute suppurative thyroiditis, AST) is a very rare condition, particularly in children, as the thyroid gland is extremely resistant to infection. AST presents with painful tender mass in the anterior neck and is usually associated with fever, sore throat, dysphagia and limitation of the neck movements. In the most cases the left globe is affected. Common laboratory findings are leukocytosis, elevated erythrocyte sedimentation rate (ESR), increased C-reactive protein (CRP) and normal thyroid function. Ultrasonography (US) shows in the early stages heterogeneous echogenicity of the affected thyroid lobe with hyperperfusion of the gland. We report one 6 year old girl which presented with painless enlargement of the neck area for 2 days. She had no history of fever or sore throat. On palpation rock hard neck mass. Laboratory tests showed no increase of the white blood cell count (8.2/nl), CRP was 7.8 mg/l and ESR 23 mm/hr. The US revealed a 2.2 cm × 1.4 cm -sized hypoechoic lesion of the left thyroid lobe with inflammatory changes. Thyroid function testing was normal.Thyroid autoantibodies were negative. Serum Calcitonin was elevated with 14,2 µg/l (normal range <9.8 µg/l). In the following days the neck mass became larger with tenderness and erythema of the skin. The child remained asymptomatic. The US showed progressive enlargement of the lesion without abscess formation.The white blood cell count and CRP remained low, but the ESR elevated after one week to 47 mm/hr. We performed a fine needle aspiration to identify infectious organisms and rule out malignancy. The cytology was negative for malignancy. Prevotella oris was detected on the culture antibiogram. The girl was treated with Clindamycin for 6 weeks. The ESR and Calcitonin levels returned to normal within 4 weeks after begin of the therapy. AST is very rare in childhood but should be considered as differential diagnosis of neck mass. AST may sometimes present with atypical findings without pain, without systemic reactions and with only mild laboratory changes. The thyroid function remains mostly normal. Serum calcitonin levels can be elevated in infectious thyroiditis and are not associated with malignancy. AST can be successfully treated with appropriate antibiotics. Recurrent infections need further assessment of the presence of anatomical defects as pyriform fistula. In our case we decided for a “wait and see” strategy, as sometimes a persistent pyriform sinus tract may close as result of the previous thyroid infection.
22 Sep 2021 - 26 Sep 2021