化脓性甲状腺炎1例报道并文献复习

A case report of suppurative thyroiditis and the literature review

目的探讨化脓性甲状腺炎的临床特征、鉴别诊断及治疗方法。方法分析2018年3月29日中日友好医院内分泌科收治的1例以"反复发热、颈前肿痛1月余"为主诉就诊患者的临床资料,包括诱因、症状、体征、病程进展、化验检查、甲状腺超声、治疗等,并复习相关文献。结果患者主要表现为1个月余的反复高热,伴颈前区疼痛,且应用非甾体类药物及抗生素治疗效果均欠佳。随后颈前区肿物逐渐增大,并出现局部破溃、流脓。甲状腺超声检查:早期示混合回声包块,后期示甲状腺内液性暗区形成。经手术将肿物切开引流,清除坏死组织,抗感染等治疗后,患者病情好转。结论化脓性甲状腺炎早期需要注意与亚急性甲状腺炎相鉴别。化脓性甲状腺炎脓肿形成后是单纯切开引流抗感染治疗,还是手术治疗清除病灶,应视感染灶大小及是否累及周围血管神经而定,临床医生应时刻警惕,不可掉以轻心。

Objective To investigate the clinical manifestation,differential diagnosis and therapeutic methods of suppurative thyroiditis.Method A patient was admitted to China-Japan Friendship Hospital with a chief complaint of ’recurrent fever,anterior cervical swelling and pain for more than 1 month’,on March 29 th 2018.This case was analyzed from the aspects of precipitating factors,symptoms,signs,progression,laboratory tests,examinations,thyroid ultrasound and therapeutic advices.Relevant literature was reviewed.Result The35-year-old male patient presented with recurrent fever,anterior cervical swelling and pain for more than 1 month.During this month,non-steroidal anti-inflammatory drugs(NSAIDs)and antibiotics did not have much effects.On the contrary,the anterior cervical swelling gradually increased,and finally ulcerated and suppurated.Thyroid ultrasound manifested hybrid echo-mass at early stage and fluid sonolucent area at later stage.Surgery was conducted for incision and drainage of the abscess and remove of the necrotic tissue.At the same time,antibiotic medication was applied.The patient’s condition was getting better.Conclusion Attention should be payed to distinguish suppurative thyroiditis from subacute thyroiditis at early stage.Once the abscess forms due to suppurative thyroiditis,the size of the abscess and its invasion to the nearby organ determine whether simply applying incision and drainage of the abscess,or conducting surgery to remove the abscess and necrotic tissue.Clinical physicians should pay close attention to such cases.