急性化脓性甲状腺炎1例报道并文献复习

doi:10.3969/j.issn.1674-8115.2022.10.018

摘要/Abstract

摘要：

急性化脓性甲状腺炎（acute suppurative thyroiditis，AST）是一种极少见且可能致命的甲状腺疾病。该文报道了1名以“咽痛1月伴左侧颈部包块2周”为主要表现的病例，其临床表现不典型，治疗初期被误认为亚急性甲状腺炎，曾予糖皮质激素治疗；后因疗效不佳，行超声引导下细针穿刺活检后，明确了AST的诊断。与此同时，该文就历年来年龄≥50岁的AST患者的特点进行分析。

关键词: 急性化脓性甲状腺炎, 亚急性甲状腺炎, 超声引导下细针穿刺

Abstract:

Acute suppurative thyroiditis (AST) is a rare and possibly fatal thyroid disease. A case with "sore throat one month accompanied by left neck mass for two weeks" as the main presentation was reported. The clinical presentation was atypical, and was mistaken for subacute thyroiditis. She was treated with glucocorticoid. The diagnosis of AST was confirmed after ultrasound-guided fine needle aspiration, due to poor efficacy. The features of AST patients over the age of fifty years were also analyzed.

Key words: acute suppurative thyroiditis (AST), subacute thyroiditis, ultrasound-guided fine needle aspiration

中图分类号:

R581.4

王娟, 陈其谋, 刘其聪, 陈光敏, 蒋鹏, 张瑞, 周厚地. 急性化脓性甲状腺炎1例报道并文献复习[J]. 上海交通大学学报（医学版）, 2022, 42(10): 1504-1510.

WANG Juan, CHEN Qimou, LIU Qicong, CHEN Guangmin, JIANG Peng, ZHANG Rui, ZHOU Houdi. Acute suppurative thyroiditis: a case report and literature review[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(10): 1504-1510.

图/表 3

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Case No.	Age/year	Gender	Cause/Contributing factor	Systemic symptom	WBC count status	Thyroid function test	Affected side	Initial thyroid ultrasound	Bacterial culture result	Aspiration or surgical drainage	Reference
1	61	F	Goiter	Haven	Elevated	TSH↓，fT4，TT4↑，fT3 and TT3（-）	Bilateral	Nontypical	Negative culture	None	^［7］
2	57	M	None	Haven	Normal	Normal	Left	/	Staphylococcus aureus	Surgical drainage	^［8］
3	64	M	None	None	Normal	Normal	Right	/	Pseudotuberculosis bacilli	Surgical drainage	^［8］
4	70	M	None	Haven	Elevated	TSH↓，T3 and T4（-）	Right	Nontypical	Acinetobacter baumannii	Aspiration	^［9］
5	54	F	None	Haven	Elevated	T3，T4，fT3 and fT4↑	Bilateral	Nontypical	/	Surgical drainage	^［10］
6	72	F	Multinodular goiter， and DM	None	Elevated	Normal	Right	Nontypical	Staphylococcus aureus	Surgical drainage	^［11］
7	79	F	DM， colorectal cancer， cirrhosis， chronic renal failure， and thyroid nodule	Haven	Elevated	TSH↓ and fT4（-）	Right	Nontypical	Salmonellatyphimurium	Surgical drainage	^［12］
8	50	F	Fine needle aspirate	Haven	Elevated	/	Left	/	Streptococcus and anaerobes	Surgical drainage	^［13］
9	81	F	Multinodular goiter	Haven	Elevated	TSH↓ and TT4（-）	Left	Nontypical	Escherichia coli	Surgical drainage	^［14］
10	52	F	None	Haven	Elevated	/	Left	Nontypical	/	Aspiration	^［15］
11	62	M	Fish bone	Haven	Elevated	fT4↑ and TSH↓	Left	Typical	Gram-positive cocci and gram-negative bacillus	Aspiration and surgical drainage	^［16］
12	74	M	Renal transplantation and received immunosuppresants and glucocorticoid treatment	Haven	Elevated	/	Right	Typical	Salmonella enteritidis	Surgical drainage	^［17］
13	71	M	Fish bone	Haven	Elevated	/	Right	Typical	Streptococcus bovis	Surgical drainage	^［18］
14	75	F	Multinodular goiter and DM	None	Elevated	Normal	Right	/	Klebsiella	Surgical drainage	^［19］
15	61	M	Infectious endocarditis， thyroid nodule， and glucose intolerance	Haven	Elevated	TSH↓，fT3 and fT4↑	Right	Nontypical	Methicillin-resistant Staphylococcus aureus	None	^［20］
16	78	F	Multinodular goiter	Haven	Elevated	/	Right	/	Negative culture	Surgical drainage	^［21］
17	63	F	Thyroid follicular carcinoma	Haven	Elevated	TSH↑	Right	Typical	/	Surgical drainage	^［22］
18	70	F	None	Haven	Elevated	TSH↓，fT3 and fT4↑	Right	Nontypical	Negative culture	Surgical drainage	^［23］
19	50	F	HIV infection	Haven	/	/	Left	Typical	Negative culture	Surgical drainage	^［24］
20	60	F	DM	Haven	Elevated	Normal	Left	/	Escherichia coli	Surgical drainage	^［25］
21	56	M	Fish bone	Haven	Normal	T3↓，TSH and T4（-）	Left	Nontypical	Brucella	Surgical drainage	^［26］
22	61	M	None （received glucocorticoid treatment）	Haven	Elevated	/	Left	/	Negative culture	Surgical drainage	^［27］
23	51	F	None （received glucocorticoid treatment）	Haven	Elevated	TSH↓，fT3 and fT4↑	Right	Nontypical	Methicillin-resistant Staphylococcus aureus	Aspiration	^［28］
24	80	F	Preexisting adenomatous goiter （received glucocorticoid treatment）	Haven	Elevated	TSH↓ and fT4↑	Left	Nontypical	Streptococcus agalactiae	None	^［29］
25	56	F	Multinodular goiter，received glucocorticoid treatment for autoimmune disease and DM	Haven	Elevated	Normal	Right	/	Aspergillus fumigatus	Aspiration	^［30］
26	57	F	DM and multinodular goiter	Haven	Elevated	Normal	Right	/	Staphylococcus species	Surgical drainage	^［31］
27	55	M	None	Haven	Elevated	TT4↑，TSH and TT3（-）	Bilateral	Typical	Brucella	None	^［32］
28	54	M	DM	Haven	Elevated	TSH↓，fT3 and fT4（-）	Left	Nontypical	Staphylococcus aureus， Streptococcus pyogenes	Surgical drainage	^［33］
29	54	M	Renal cell carcinoma	Haven	Elevated	TSH↓ and fT4↑	Right	/	Escherichia coli	Aspiration	^［34］
30	73	F	None	Haven	Elevated	Normal	Left	Typical	Negative culture	Aspiration and surgical drainage	^［34］
31	68	F	Sepsis	Haven	Elevated	/	Left	/	Candida， Streptococcus sanguinis	Surgical drainage	^［34］
32	58	F	DM and left sided goiter	Haven	Elevated	TSH↑，T3 and T4（-）	Right	Typical	Salmonella species	Aspiration	^［35］
33	66	M	DM， multinodal goiter and esophageal cancer	Haven	Elevated	TSH↓，fT3 and fT4↑	Left	Nontypical	Staphylococcus	Aspiration	^［36］
34	85	F	Thyroid nodule	Haven	Elevated	TSH↓，fT4↑ and fT3（-）	Right	Nontypical	Klebsiella pneumoniae	Surgical drainage	^［37］
35	55	F	DM and right colloid thyroid lobe nodule	Haven	Elevated	/	Right	Nontypical	Negative culture	Aspiration	^［38］
36	57	F	DM and colon perforation	Haven	Elevated	TSH↓ and fT4↑	Left	Nontypical	Bacteroides fragilis	Aspiration	^［39］
37	55	F	DM	None	Elevated	TSH↓，fT4↑ and fT3（-）	Left	Nontypical	Negative culture	Surgical drainage	Present case

Case No.	Age/year	Gender	Cause/Contributing factor	Systemic symptom	WBC count status	Thyroid function test	Affected side	Initial thyroid ultrasound	Bacterial culture result	Aspiration or surgical drainage	Reference
1	61	F	Goiter	Haven	Elevated	TSH↓，fT4，TT4↑，fT3 and TT3（-）	Bilateral	Nontypical	Negative culture	None	^［7］
2	57	M	None	Haven	Normal	Normal	Left	/	Staphylococcus aureus	Surgical drainage	^［8］
3	64	M	None	None	Normal	Normal	Right	/	Pseudotuberculosis bacilli	Surgical drainage	^［8］
4	70	M	None	Haven	Elevated	TSH↓，T3 and T4（-）	Right	Nontypical	Acinetobacter baumannii	Aspiration	^［9］
5	54	F	None	Haven	Elevated	T3，T4，fT3 and fT4↑	Bilateral	Nontypical	/	Surgical drainage	^［10］
6	72	F	Multinodular goiter， and DM	None	Elevated	Normal	Right	Nontypical	Staphylococcus aureus	Surgical drainage	^［11］
7	79	F	DM， colorectal cancer， cirrhosis， chronic renal failure， and thyroid nodule	Haven	Elevated	TSH↓ and fT4（-）	Right	Nontypical	Salmonellatyphimurium	Surgical drainage	^［12］
8	50	F	Fine needle aspirate	Haven	Elevated	/	Left	/	Streptococcus and anaerobes	Surgical drainage	^［13］
9	81	F	Multinodular goiter	Haven	Elevated	TSH↓ and TT4（-）	Left	Nontypical	Escherichia coli	Surgical drainage	^［14］
10	52	F	None	Haven	Elevated	/	Left	Nontypical	/	Aspiration	^［15］
11	62	M	Fish bone	Haven	Elevated	fT4↑ and TSH↓	Left	Typical	Gram-positive cocci and gram-negative bacillus	Aspiration and surgical drainage	^［16］
12	74	M	Renal transplantation and received immunosuppresants and glucocorticoid treatment	Haven	Elevated	/	Right	Typical	Salmonella enteritidis	Surgical drainage	^［17］
13	71	M	Fish bone	Haven	Elevated	/	Right	Typical	Streptococcus bovis	Surgical drainage	^［18］
14	75	F	Multinodular goiter and DM	None	Elevated	Normal	Right	/	Klebsiella	Surgical drainage	^［19］
15	61	M	Infectious endocarditis， thyroid nodule， and glucose intolerance	Haven	Elevated	TSH↓，fT3 and fT4↑	Right	Nontypical	Methicillin-resistant Staphylococcus aureus	None	^［20］
16	78	F	Multinodular goiter	Haven	Elevated	/	Right	/	Negative culture	Surgical drainage	^［21］
17	63	F	Thyroid follicular carcinoma	Haven	Elevated	TSH↑	Right	Typical	/	Surgical drainage	^［22］
18	70	F	None	Haven	Elevated	TSH↓，fT3 and fT4↑	Right	Nontypical	Negative culture	Surgical drainage	^［23］
19	50	F	HIV infection	Haven	/	/	Left	Typical	Negative culture	Surgical drainage	^［24］
20	60	F	DM	Haven	Elevated	Normal	Left	/	Escherichia coli	Surgical drainage	^［25］
21	56	M	Fish bone	Haven	Normal	T3↓，TSH and T4（-）	Left	Nontypical	Brucella	Surgical drainage	^［26］
22	61	M	None （received glucocorticoid treatment）	Haven	Elevated	/	Left	/	Negative culture	Surgical drainage	^［27］
23	51	F	None （received glucocorticoid treatment）	Haven	Elevated	TSH↓，fT3 and fT4↑	Right	Nontypical	Methicillin-resistant Staphylococcus aureus	Aspiration	^［28］
24	80	F	Preexisting adenomatous goiter （received glucocorticoid treatment）	Haven	Elevated	TSH↓ and fT4↑	Left	Nontypical	Streptococcus agalactiae	None	^［29］
25	56	F	Multinodular goiter，received glucocorticoid treatment for autoimmune disease and DM	Haven	Elevated	Normal	Right	/	Aspergillus fumigatus	Aspiration	^［30］
26	57	F	DM and multinodular goiter	Haven	Elevated	Normal	Right	/	Staphylococcus species	Surgical drainage	^［31］
27	55	M	None	Haven	Elevated	TT4↑，TSH and TT3（-）	Bilateral	Typical	Brucella	None	^［32］
28	54	M	DM	Haven	Elevated	TSH↓，fT3 and fT4（-）	Left	Nontypical	Staphylococcus aureus， Streptococcus pyogenes	Surgical drainage	^［33］
29	54	M	Renal cell carcinoma	Haven	Elevated	TSH↓ and fT4↑	Right	/	Escherichia coli	Aspiration	^［34］
30	73	F	None	Haven	Elevated	Normal	Left	Typical	Negative culture	Aspiration and surgical drainage	^［34］
31	68	F	Sepsis	Haven	Elevated	/	Left	/	Candida， Streptococcus sanguinis	Surgical drainage	^［34］
32	58	F	DM and left sided goiter	Haven	Elevated	TSH↑，T3 and T4（-）	Right	Typical	Salmonella species	Aspiration	^［35］
33	66	M	DM， multinodal goiter and esophageal cancer	Haven	Elevated	TSH↓，fT3 and fT4↑	Left	Nontypical	Staphylococcus	Aspiration	^［36］
34	85	F	Thyroid nodule	Haven	Elevated	TSH↓，fT4↑ and fT3（-）	Right	Nontypical	Klebsiella pneumoniae	Surgical drainage	^［37］
35	55	F	DM and right colloid thyroid lobe nodule	Haven	Elevated	/	Right	Nontypical	Negative culture	Aspiration	^［38］
36	57	F	DM and colon perforation	Haven	Elevated	TSH↓ and fT4↑	Left	Nontypical	Bacteroides fragilis	Aspiration	^［39］
37	55	F	DM	None	Elevated	TSH↓，fT4↑ and fT3（-）	Left	Nontypical	Negative culture	Surgical drainage	Present case