Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-1421. doi: 10.1089/thy.2016.0229. Erratum in: Thyroid. 2017 Nov;27(11):1462. PMID: 27521067.
Elsheikh TM. Diagnostic Terminology and Criteria for the Cytologic Diagnosis of Thyroid Lesions. Papanicolaou Society of Cytopathology Guidelines. http://www.papsociety.org/guidelines/. Accessed January 28, 2016.
Shrestha RT, Hennessey J. Acute and Subacute, and Riedel’s Thyroiditis. 2015 Dec 8. In: Feingold KR, Anawalt B, Boyce A, et al, eds. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905408.
Pearce SH, Brabant G, Duntas LH, et al. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J. 2013 Dec;2(4):215-28. doi: 10.1159/000356507. Epub 2013 Nov 27. PubMed PMID: 24783053; PubMed Central PMCID: PMC3923601.
Garber JR, Cobin RH, Gharib H, et al; American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012 Nov-Dec;18(6):988-1028. Erratum in: Endocr Pract. 2013 Jan-Feb;19(1):175. PubMed PMID: 23246686.
De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012 Aug;97(8):2543-65. doi: 10.1210/jc.2011-2803. PMID: 22869843.
Stagnaro-Green A, Abalovich M, Alexander E, et al; American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011 Oct;21(10):1081-125. doi: 10.1089/thy.2011.0087. Epub 2011 Jul 25. PubMed PMID: 21787128; PubMed Central PMCID: PMC3472679.
Jarząb B, Sporny S, Lange D, et al; Polish Endocrinology Society; Polish Thyroid Society; Polish Pathologic Society; Society of Polish Surgeons; Polish Society of Surgical Oncology; Polish Oncologic Society; Polish Society of Nuclear Medicine; Polish Society of Pediatric Endocrinology; Polish Society of Pediatric Surgery; Polish Society of Ultrasonography. [Diagnosis and treatment of thyroid cancer - Polish guidelines]. Endokrynol Pol. 2010 Sep-Oct;61(5):518-68. Polish. PubMed PMID: 21049469.
Gharib H, Papini E, Paschke R, et al; AACE/AME/ETA Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract. 2010 May-Jun;16 Suppl 1:1-43. doi: 10.4158/10024.GL. PubMed PMID: 20497938.
American Thyroid Association Guidelines Task Force, Kloos RT, Eng C, Evans DB, et al. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid. 2009 Jun;19(6):565-612. doi: 10.1089/thy.2008.0403. Review. Erratum in: Thyroid. 2009 Nov;19(11):1295. PubMed PMID: 19469690.
Bartalena L, Baldeschi L, Dickinson AJ, et al. Consensus statement of the European group on Graves' orbitopathy (EUGOGO) on management of Graves' orbitopathy. Thyroid. 2008 Mar;18(3):333-46. doi:10.1089/thy.2007.0315. PubMed PMID: 18341379.
1. Acute bacterial (suppurative) thyroiditis is rare. Infection spreads by the hematogenous route or by continuity from adjacent tissues.
Etiology: Streptococci (Streptococcus pyogenes), staphylococci (Staphylococcus aureus), less frequently Escherichia coli and Salmonella typhimurium; in recurrent infections, anaerobic bacteria. The disease initially manifests as a painful swelling of the thyroid gland with fever and rigors. Patients may have difficulty extending the neck and may experience pain with swallowing. They may prefer sitting with the neck flexed to decrease pressure on the thyroid gland. Formation of an abscess is accompanied by painful regional lymphadenopathy. Thyroid function is usually normal.
Ultrasonography shows decreased heterogeneous echogenicity of the abscess. On radionuclide imaging the abscess is “cold” and shows no radionuclide uptake. Cytology shows only purulent contents (send a sample for culture and antibiotic susceptibility). White blood cell counts are high and erythrocyte sedimentation rate is markedly elevated.
The treatment of choice is inpatient antibiotic therapy and surgical drainage of the abscess or a total or partial surgical resection of the affected thyroid gland. Immediately after collecting samples for microbiology start empiric antibiotic therapy based on risk factors, severity of infection, previous history of allergic reactions to antibiotics, and recently used antimicrobial treatment.
2. Radiation-induced thyroiditis usually develops after radioiodine administration. Following the acute inflammatory phase, patients can develop hypothyroidism. The disease may also occur after external beam irradiation used in oncology; in such cases it appears late, has no acute phase, and is termed “radiation-induced hypothyroidism.”
3. Thyroiditis caused by trauma (including vigorous palpation) of the thyroid gland.
4. Drug-induced thyroiditis: Some drugs, such as, lithium, interferon alpha, interleukin 2, amiodarone, and tyrosine kinase inhibitors, may cause symptoms of acute thyroiditis. Amiodarone-induced thyroiditis: see Other Types of Chronic Thyroiditis.