Acute bacterial suppurative thyroiditis: a clinical review and expert opinion.
BACKGROUND
Acute suppurative thyroiditis (AST) resulting from a bacterial infection is an infrequent but potentially life-threatening endocrine emergency. Traditional management of this disease has been surgery in conjunction with targeted antibiotic therapy. Recent nonrandomized reports of small series have demonstrated good outcomes using less invasive approaches. No randomized clinical trials have been performed. Here, we provide a review of the literature and an approach to this problem based on expert opinion.


METHODS
The literature was reviewed utilizing PubMed, and a representative case of AST was presented to a panel of experts. Endocrinology, surgery, and infectious disease experts responded to a series of questions regarding diagnosis, management, prognosis, and harm.


RESULTS
Combining a broad spectrum of clinical expertise and the published literature, the authors suggest a clinical algorithm as a guide to management, addressing both diagnosis and acute and long-term management.


CONCLUSIONS
Published studies indicate a trend toward less invasive management during active inflammation and infection and regarding definite therapy. Remaining questions are presented to foster an evidence-based approach to this disease. Ideally, future randomized, controlled trials will provide data to improve the therapy and outcome of AST.
Endocrinology, Diabetes, and Metabolism Feedback Consulting, LLC and Westerville Medical Associates Central Ohio Primary Care Physicians, Inc., Westerville, Ohio 43081, USA. johnpaes@medscape.com
John E
JE
Paes
Kenneth D
KD
Burman
James
J
Cohen
Jayne
J
Franklyn
Christopher R
CR
McHenry
Shmuel
S
Shoham
Richard T
RT
Kloos
D001424:Bacterial Infections / Q000175:diagnosis* / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic; D013969:Thyroiditis, Suppurative / Q000175:diagnosis* / Q000628:therapy*