Infectious Thyroiditis in Children: A Challenging Diagnosis and Management

Only few studies have investigated to now whether the association with Turner syndrome (TS) may affect the course of Hashimoto's thyroiditis (HT) in children. Aim of this study was to ascertain whether the presentation and long-term course of HT in TS children may be characterized by a peculiar and atypical pattern. The clinical and biochemical findings at HT diagnosis in 90 TS children (group A) were compared with those recorded in 449 girls with HT but without TS (group B); in group A patients, thyroid function tests were re-evaluated after a median time interval of 4.9 years. At HT diagnosis median TSH levels and the rate of cases presenting with a thyroid dysfunction picture were significantly lower in group A, irrespective of karyotype abnormalities. In group A only 34.8 % of the girls who had initially presented with euthyroidism remained euthyroid even at re-evaluation, whilst 67.7 % of those who had presented with subclinical hypothyroidism became overtly hypothyroid over time; also such evolutive pattern was irrespective of karyotype abnormalities. (1) In TS girls, HT presents with a milder hormonal pattern, which often deteriorates over time; (2) these biochemical features are not necessarily linked with a specific karyotype.

With regard to their thyroid function, somatic and intellectual development, we compared 17 children of 13 hyperthyroid mothers (group I) receiving antithyroid drug treatment during their pregnancies with 25 children of 15 mothers who were euthyroid without any antithyroid treatment during their pregnancy (group II). Mean duration of maternal treatment was 3.5 months in group I, using carbimazole or thiamazole (N = 12) and propylthiouracil (N = 1). Age at examination in group I was 7.2 +/- 6.2 years, in group II 8.7 +/- 7.1 years (mean +/- SD). Both groups showed no significant differences in the results of the clinical examination and in the degree of their mental and psychomotoric development at the time of study. We found the mean birth weight of the infants in group I significantly lower than in group II (3165 +/- 339 vs 3666 +/- 670 g, p less than 0.03). The individual birth weights, however, were normal for gestational age. The body weight difference between groups disappeared during the further somatic development of the children. The serum concentration of free thyroxine in group I was significantly higher than in group II (17.2 +/- 2.4 vs 14.9 +/- 1.9 pmol/l, p less than 0.003), but fell in both groups within the normal range. The evaluation of the psychomotoric and intellectual capacity of the children at different developmental stages showed no abnormalities detectable by our tests. Thus, in the children of the two groups we found no adverse effects of a maternal antithyroid drug treatment during pregnancy or of inactive maternal Graves' disease alone, neither on thyroid gland size and function nor on the physical or intellectual development, after the neonatal period.

The ability of the thyroid gland to withstand infection is a well known phenomenon. In this regard, inflammatory disease of the thyroid gland in children is an uncommon occurrence. The frequency with which this proceeds to abscess formation is rare. Review of the literature of the past 25 years reveals only 21 reported cases of acute suppurative thyroiditis in children, only one of which has been reported in the otolaryngologic literature. We report two cases of thyroid abscess in children initially presented as painful swellings in the lower neck. An overview of the management of these patients is detailed, including a discussion of the appropriate utilization of diagnostic studies. Demonstration of an internal fistula originating from the pyriform sinus underscores the need to consider a fourth branchial arch remnant as a possible source of infection. The importance of obtaining appropriate bacterial, fungal, and acid-fast cultures is stressed, as is the role of antibiotic therapy and definitive surgery once the diagnosis of thyroid abscess is made.

Ultrasonography (US) is the imaging method of choice for evaluating the pediatric thyroid gland, complemented by scintigraphy and thyroid function tests, especially when evaluating children with suspected congenital hypothyroidism, goiter, infectious or autoimmune diseases, or neoplasm. Diagnostic considerations in newborns with congenital hypothyroidism mainly include dysgenesis, dyshormonogenesis, transient hypothyroidism and central (hypophyseal) hypothyroidism. The midline of the neck should be scrutinized for thyroid tissue from the floor of the mouth to the thoracic inlet. Cystic and echogenic ultimobranchial remnants should not be misinterpreted as orthotopic thyroid tissue. Diffuse thyroid diseases affect older children; these comprise Hashimoto and Graves diseases and infectious thyroiditis and exhibit features similar to those in adults. It is important to note that the diffuse sclerosing variant of papillary thyroid cancer can complicate thyroiditis and should not be confused with Hashimoto disease. In children with solid nodules the threshold for fine-needle aspiration biopsy or surgery should be lower compared to adults because of a higher likelihood of malignancy compared with adults. Biopsy should be considered in nodules with suspicious ultrasonographic features, even when smaller than 1cm. Adult classification systems of thyroid nodules, although useful, are not sufficient to safely discriminate the nodules' likelihood of malignancy in children. We describe key sonographic findings and suggest a standard checklist that might be considered while performing and interpreting thyroid US in neonates and children.

To study the presentation, management, and long-term outcome of children presenting with lingual thyroid. Institutional review board approved, retrospective study (1993-2004). The study was conducted at a tertiary care pediatric medical center. The main outcomes measured were initial presentation, radiographic findings, endocrine evaluation, surgical outcome, pathologic features, complications, need for hormonal replacement. Four patients presented to the Department of Otolaryngology and Communications Enhancement, Children's Hospital Boston with lingual thyroid between 1993 and 2004. All patients were female, with an age range of 2 to 12 years (x = 6). All patients presented with a mass (1.4-3.5 cm) and most with respiratory or feeding difficulty. Magnetic resonance imaging was obtained in three patients and revealed a mass consistent with lingual thyroid. Thyroid scan confirmed the lingual thyroid as the only functioning thyroid in all four patients. None of the patients responded to hormonal replacement, and all underwent surgical excision of the mass. Surgical approach included midline glossotomy (n = 2) and CO2 laser excision (n = 2). Pathologic evaluation confirmed lingual thyroid in all four patients. No evidence of malignancy was seen in any patient. All four patients require lifelong hormonal replacement. Lingual thyroid is a rare condition, with an incidence of 1:100,000. This infrequent congenital anomaly is often asymptomatic until a pathologic stress such as systemic disease or physiologic stress such as puberty causes enlargement of the ectopic tissue, leading to dysphagia, dysphonia, and dyspnea. The work-up should include routine blood work including thyroid function tests thyrotropin, thyroxine, and thyroid hormone binding ratio; iodine thyroid scintigraphy; and computerized tomography or magnetic resonance imaging. The majority of patients require surgical excision of the symptomatic mass and, in case of absence of orthotopic thyroid tissue, long-term thyroid hormone replacement.

Introduction. Esophageal achalasia is a neurodegenerative motility disorder, which is characterized by ineffective or absent esophageal peristalsis and the lack of hypertonic lower esophageal sphincter relaxation. Achalasia causes failure to thrive in children and can have serious respiratory complications. Achalasia is a very rare condition in pediatric population, and usually misdiagnosed as gastroesophageal reflux. The treatment of choice is Heller esophagocardiomyotomy. The aim of this paper is to present a rare case of a two-year-old child with achalasia, diagnostic procedures, and successful operative treatment. Case outline. The patient?s problems started at the age of six months, with audible breathing and respiratory stridor. The child was admitted at a local hospital at seven months of age, dismissed with dietary advices, again admitted at the age of 19 months, and transferred to our institution. Upper gastrointestinal series and computed tomography revealed findings characteristic for achalasia, and on esophagoscopy exam there was no opening of lower esophageal sphincter and cardia on insufflation. Pneumatic dilation was performed with temporary improvement. Laparotomic Heller esophagocardiomyotomy with Dor partial fundoplication was successfully performed. Conclusion. Achalasia is a very rare condition in infants and young children. There is often a delay when establishing the correct diagnosis. Upper gastrointestinal series and endoscopic exam are most reliable methods to detect achalasia. Pharmacological treatment, intrasphincteric injection of botulinum toxin and pneumatic dilations are not efficient methods, especially in small children. The method of choice in the treatment of achalasia is Heller esophagocardiomyotomy with partial fundoplication.

Branchial cleft anomalies are rare diseases of head and neck region. Second branchial cleft anomalies represent more than 95% of all branchial cleft anomalies. Second branchial cleft cyst is a benign developmental cyst due to the incomplete obliteration of pharyngeal cleft. A 46-year-old female patient reported to hospital with a complaint of swelling over the left side of the neck since 4 to 5 months. On clinical examination, swelling was seen below and behind the angle of mandible on the left side. The patient was evaluated using ultrasound and contrast enhanced computerized tomography (CECT) of neck which revealed second left bronchial cleft cyst/enlarged cystic lymph-node. Fine needle aspiration cytology of the swelling showed features of cystic lesion. Type-I branchial cleft cyst is a rare condition with a significant risk of misdiagnosis. To avert misdiagnosis and surgical complications, thorough investigation must be performed prior to surgical intervention.

We present 3 new cases of cervical epidural abscess (CEA), a rare condition, along with a review of 12 other case reports. The average patient age was 45 years; just over half were male. The abscesses usually involved the mid to lower cervical region and extended an average of three to four segments. Neck stiffness was present in all patients; root pain and paresthesias were present less often. Weakness of one to four extremities developed in all but one patient. Sensory levels were frequently present, sometimes below the site of the lesion. All but two patients were febrile. All but two had elevated CSF protein, and all but two had a pleocytosis; myelography always revealed a complete or partial block. Staphylococcus aureus was the causative organism in 8 of 11 patients. CEA should be considered in a patient with neck stiffness, paresthesias, and/or radicular pain so that CT or myelography followed by surgical decompression and/or antimicrobial drugs can be initiated before prolonged weakness develops. One of our patients developed a syrinx causing a new neurologic deficit 3 years after treatment. Delayed syringomyelia, a rare complication of extramedullary lesions, lends support to vascular occlusion as the major mechanism of damage in epidural abscess.

Normal intellectual development in children born from women with hypothyroxinemia during their pregnancy

ThyroidVol. 18, No. 10 Letters to the EditorConversion to Graves' Hyperthyroidism in a Patient with Hypothyroidism Due to Hashimoto's Thyroiditis Documented by Real-Time Thyroid UltrasonographyBernard Champion, Bamini Gopinath, Gary Ma, Samer El-Kaissi, and Jack R. WallBernard ChampionSearch for more papers by this author, Bamini GopinathSearch for more papers by this author, Gary MaSearch for more papers by this author, Samer El-KaissiSearch for more papers by this author, and Jack R. WallSearch for more papers by this authorPublished Online:9 Oct 2008https://doi.org/10.1089/thy.2008.0142AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byDiseases of Thyroid1 April 2023Autoimmune thyroid diseases: Peculiarities in pediatric ageThe effect of radioiodine treatment on the characteristics of TRAb in Graves’ disease30 November 2021 | BMC Endocrine Disorders, Vol. 21, No. 1Unusual Presentation and Rare Comorbidity of Graves-Basedow’s Disease in Children1 December 2021Ultrasonographic Findings in Common Thyroid and Parathyroid Disorders—Advantages of Real Time Observation by the Endocrinologist with their Own Ultrasound Machine23 March 2021 | Reports, Vol. 4, No. 1The clinical phenotype of Graves’ disease occurring as an isolated condition or in association with other autoimmune diseases12 August 2019 | Journal of Endocrinological Investigation, Vol. 43, No. 2Establishment of clinical diagnosis model of Graves’ disease and Hashimoto’s thyroiditis7 January 2019 | Journal of Translational Medicine, Vol. 17, No. 1Thyroid function test evolution in children with Hashimoto’s thyroiditis is closely conditioned by the biochemical picture at diagnosis7 February 2018 | Italian Journal of Pediatrics, Vol. 44, No. 1Hashimoto's Disease and Thyroid Cancer in Children: Are They Associated?9 October 2018 | Frontiers in Endocrinology, Vol. 9Association of Endocrine Conditions With Takotsubo Cardiomyopathy: A Comprehensive ReviewJournal of the American Heart Association, Vol. 7, No. 19Diseases of Thyroid6 December 2017Conversion to Graves disease from Hashimoto thyroiditis: a study of 24 patients1 January 2018 | Archives of Endocrinology and Metabolism, Vol. 62, No. 6Five-Year Prospective Evaluation of Thyroid Function Test Evolution in Children with Hashimoto's Thyroiditis Presenting with Either Euthyroidism or Subclinical Hypothyroidism Tommaso Aversa, Andrea Corrias, Mariacarolina Salerno, Daniele Tessaris, Raffaella Di Mase, Mariella Valenzise, Domenico Corica, Filippo De Luca, and Malgorzata Wasniewska1 October 2016 | Thyroid, Vol. 26, No. 10The association with Turner syndrome significantly affects the course of Hashimoto’s thyroiditis in children, irrespective of karyotype27 December 2014 | Endocrine, Vol. 50, No. 3Peculiarities of autoimmune thyroid diseases in children with Turner or Down syndrome: an overview15 May 2015 | Italian Journal of Pediatrics, Vol. 41, No. 1Metamorphic thyroid autoimmunity in Down Syndrome: from Hashimoto’s thyroiditis to Graves’ disease and beyond11 November 2015 | Italian Journal of Pediatrics, Vol. 41, No. 1Five-year prospective evaluation of thyroid function in girls with subclinical mild hypothyroidism of different etiologyEuropean Journal of Endocrinology, Vol. 173, No. 6Autoimmune ThyroiditisConversion of autoimmune hypothyroidism to hyperthyroidism3 August 2014 | BMC Research Notes, Vol. 7, No. 1In Young Patients with Turner or Down Syndrome, Graves' Disease Presentation Is Often Preceded by Hashimoto's Thyroiditis Tommaso Aversa, Fortunato Lombardo, Andrea Corrias, Mariacarolina Salerno, Filippo De Luca, and Malgorzata Wasniewska9 April 2014 | Thyroid, Vol. 24, No. 4Male gender differences in the thyroid ultrasound features, thyroid peroxidase antibodies and thyroid hormone levels: a large population-based study9 January 2014 | Journal of Endocrinological Investigation, Vol. 37, No. 3DysthyroïdiesHashimoto's thyroiditis in childhood: presentation modes and evolution over timeItalian Journal of Pediatrics, Vol. 39, No. 1Thyrotrophin receptor antibody characteristics in a woman with long-standing Hashimoto's who developed Graves' disease and pretibial myxoedema14 August 2012 | Clinical Endocrinology, Vol. 77, No. 3Takotsubo cardiomyopathy in thyrotoxicosisInternational Journal of Cardiology, Vol. 145, No. 3Remission of Hashimoto's Thyroiditis in a Twelve-Year-Old Girl with Thyroid Changes Documented by Ultrasonography Ralph Nanan and Jack R. Wall1 October 2010 | Thyroid, Vol. 20, No. 10Atypical Thyroid Storm Caused by Metamorphosis of Thyroid Autoimmunity15 April 2010 | ICU Director, Vol. 1, No. 3Metamorphic Thyroid Autoimmunity Marian Ludgate and Charles H. Emerson9 October 2008 | Thyroid, Vol. 18, No. 10 Volume 18Issue 10Oct 2008 InformationCopyright 2008, Mary Ann Liebert, Inc.To cite this article:Bernard Champion, Bamini Gopinath, Gary Ma, Samer El-Kaissi, and Jack R. Wall.Conversion to Graves' Hyperthyroidism in a Patient with Hypothyroidism Due to Hashimoto's Thyroiditis Documented by Real-Time Thyroid Ultrasonography.Thyroid.Oct 2008.1135-1137.http://doi.org/10.1089/thy.2008.0142Published in Volume: 18 Issue 10: October 9, 2008PDF download

Introduction: Vaccination is one of the most effective ways to control the COVID-19 pandemic. However, as the number of people vaccinated against COVID-19 continues to increase, there are more reports on the safety of vaccines. So far, there have been no reported cases of spinal infection associated with COVID-19 vaccination. Recently, we admitted a patient who developed cervical Staphylococcus aureus infection resulting in high paraplegia after receiving the third dose of COVID-19 vaccine when the symptoms of cold did not completely disappear. Case presentation: The patient was a 70-year-old man who received the third injection of COVID-19 vaccine when the cold symptoms were not completely gone. On the day after the injection, the patient developed severe neck and shoulder pain, accompanied by numbness and fatigue in the limbs. MRI examination of the cervical spine on day 6 after vaccination showed no obvious signs of infection. The patient had progressive weakness in the extremities. On the ninth day after vaccination, the patient developed paralysis of both lower limbs and significant sensory loss. Cervical abscess and cervical spinal cord injury were considered for cervical CT and MRI examination on the 15th day after vaccination. We used an anterior approach to remove as much of the lesion as possible. Staphylococcus aureus was detected and antibiotic treatment was continued after surgery. The patient’s pain symptoms were significantly relieved, which prevented the abscess from further pressing the spinal cord and provided possible conditions for the recovery of neurological function in the later stage. Conclusion: This case is the first reported cervical Staphylococcus aureus infection resulting in high paraplegia after receiving the third dose of COVID-19 vaccine with low immunity. This case raises awareness of this rare but potentially life-threatening adverse reaction, and reminds people to hold off when their immune system is weakened.

Successful Management of Pheochromocytoma and Thyroiditis With Fever by Telemedicine During the COVID-19 Pandemic

Congenital cyst around external ear appearing in adulthood is rare condition. Such lesions arising around the external auditory canal that requires surgical excision are uncommon and their clinical and surgical management is often difficult because these anomalies have variable relationship with facial nerve. In this study, we investigated characteristics of congenital cysts of the external ear by analyzing their clinical and histo-pathological features. Here we described 3 unique cases with localization of an epithelial cyst, type 1 branchial cleft cyst and epidermal inclusion cyst in adults which are uncommon, congenital and rare.

Objective To analyse the clinical characteristics of infants in two months old of lingual thyroglossal duct cysts (LTGDC) and raise the levels of diagnosis and treatment. Methods A comparative analysis was made between the clinical data of 23 cases in two months old of LTGDC and those of 20 cases in one to seven years old of cervical thyroglossal duct cysts (TGDC) (control group). Results The clinical manifestation appeared obviously differences between LTGDC and TGDC. The main performance of LTGDC was laryngeal stridor, and 74% of them went to emergency department because of dyspnea. They would be misdiagnosed as congenital laryngomalacia or laryngomalacia with pneumonia. The lesion located in the posterosuperior of lingual bone and behind the root of tongue, which was easy to lead to throat obstruction because it extruded laryngeal cavity. Electronic laryngoscopy was the first choice, it helped to identify laryngomalacia, epiglottis cyst and hemangioma. Laryngeal CT or MRI was very important to diagnose LTGDC which was quasi-circular low density shadow with clear boundary, or not extruded to laryngeal cavity, or show lesion range and surrounding structures avoiding misdiagnosis. As treatment depended surgery which was self-retaining laryngoscope, it was minimally invasive and without scar. Cervical anterior mass in the midline was the first symptoms in all 20 cases of TGDC. The neck ultrasound examination was the first selection, and the lesion showed fluid dark space with clear boundary, it should take the neck percutaneous surgical operation. Conclusion The clinical manifestation of infants in two months old of LTGDC appears obviously different from TGDC. LTGDC is a common cause of laryngeal stridor with breathing difficulties. It will be misdiagnosed as congenital laryngomalacia and lead to asphyxia or death easily. Key words: Lingual thyroglossal duct cyst; Dyspnea; Infants

Although myxoma is the most common form of benign cardiac tumor, which is a rare condition itself, less than 3-4% of cases are detected in the right ventricle (RV). The clinical presentations vary widely and are nonspecific, causing challenging diagnosis. Although rare, myxoma can coexist with infective endocarditis (IE). We report a rare case of right ventricular myxoma presenting with dyspnea and fever, which was later found to be complicated with concomitant tricuspid valve endocarditis during surgery as well as the performed surgical approach. RV myxoma is a rare entity requiring a high index of suspicion due to varying nonspecific presentations. Concomitant IE should be suspected in patients with persistent fever. Antibiotics and careful surgical approach are needed to prevent complications, including embolization.