Sharp purulent tireoidit
Sharp Purulent Tireoidit (SPT) – the acute infectious disease of a thyroid gland which is followed by release of purulent exudate. The main symptoms – intensive pains in a forward part of a neck, irradiirushchy to ears and jaws, feeling of a raspiraniye of gland, fever with sharp increase in temperature up to 39-40 °C. Formation of abscess, its opening outside, in a trachea or a sredosteniye is possible. The diagnosis is established on kliniko-anamnestichesky yielded, to results of clinical trial of blood, ultrasonography and a biopsy of a thyroid gland. Treatment includes reception of antibiotics, antihistamines, dezintoksikatsionny therapy, opening and drainage of abscess.
Sharp purulent tireoidit
Tireoidit, or strumit – damage of a thyroid gland of inflammatory character. Can be purulent or not purulent, sharp or chronic. The sharp current of a purulent tireoidit is observed at bacterial, is more rare at fungal or parasitic infection of ferruterous fabric. Pathology is diagnosed seldom, occurrence makes no more than 1% of all tireoidit. The contributing factors are pregnancy and the periods of periods, in this regard among women prevalence is 4-6 times higher, than among men. The peaks of incidence of late fall and are noted in the winter when the frequency of catarrhal infections and their complications – quinsies, pneumonia, sinusitis, otitises increases.
Reasons of a sharp purulent tireoidit
In most cases the disease is provoked by bacteria – stafilokokka, streptococci, pneumococci. The inflammation of gland develops against the background of the decrease of the activity of immune system caused by an infection, a stress, pregnancy, childbirth, surgery. Carry to etiologichesky factors:
- Bacterial infections of respiratory organs. Most often the center in respiratory system becomes a source of pathogens. Widespread diseases, provocative tireoidit, pneumonia, sharp tonsillitis, sinusitis are.
- Bacterial maxillofacial infections. Sometimes pathology is provoked by infectious damages of a mouth, lymph nodes, salivary glands, bones or soft facial tissues and a neck. Therefore in risk group on development of a purulent tireoidit there are patients with caries, a pulpitis, gingivity, stomatitis, osteomyelitis of bones of a facial skeleton.
- Fungal and parasitic infections. Sharp tireoidita of the parasitic and fungal nature are diagnosed seldom, can be found in patients with echinococcosis and actinomycosis.
- Syphilis. The sharp and subsharp current of a tireoidit is characteristic of a syphilitic infection. Purulent sharp forms meet extremely seldom.
Causative agents of an infection arrive to a thyroid gland on lymphatic or blood vessels. There is an inflammatory reaction on the limited site or diffuzno, on all body. Mainly the left share is surprised. At a stage of alteration of a bacterium contact to ferruterous fabric, provoke damage and death of cages. From cellular structures enzymes are released, in surrounding connecting fabric metabolism is broken, nedookislenny products of exchange collect, acidosis develops. Vessels extend, blood supply amplifies, there is local hyperaemia and a hyperthermia.
Permeability of capillary walls increases, through them in a zone of defeat there are leukocytes, macrophages and plasma. The hypostasis irritating the nervous terminations is formed, the pain syndrome appears. Process of an inflammation is regulated by a histamine, serotonin, tsitokina, elements of the curtailing system of blood. The destroyed polimorfnoyaderny leukocytes, bacteria, fabric fragments, products of a proteoliz of fabrics, proteins and some other connections become pus components. Abscess – a purulent cavity is formed. In an affected area of gland process of secretion of hormones stops, but deficiency is quickly compensated by strengthening of their production in healthy areas. Then abscess is opened, fistula on skin is formed or contents stream to the area of a sredosteniye, a trachea. Fabrics begin to be restored, regeneration happens from the periphery to the center.
Symptoms of a sharp purulent tireoidit
The disease begins suddenly. Temperature sharply increases to 38-40 °C, the health worsens, there is fever, a fever, muscular and headaches, weakness amplifies. A forward part of a neck reddens, swells. There is intensive pain irradiating to jaws, ears, language. Pain pulsing dominates among other symptoms, is felt as intolerable. Pain considerably amplifies at the movements of the-headed, loud speech, swallowing, cough. Pressure sense and a raspiraniye around the inflammation center is added. In a thyroid gland dense painful infiltrate is palpated.
Symptoms of a hypothyroidism are absent as functions of gland remain safe. Lymph nodes of a neck inflame, become painful and increase in sizes. The health of patients quickly worsens. Symptoms of intoxication accrue – the general weakness, an ache in joints and muscles amplifies, the headache, becomes frequent heartbeat. General serious condition. Abscess is formed, in a zone of infiltrate the fluctuation center appears. Opening happens inside more often (a trachea, bodies of a sredosteniye), is more rare – outside. After that temperature temporarily decreases.
The most adverse option of a course of a disease is opening of abscess in surrounding fabrics. Hit of pus in a sredosteniye is capable to lead to a mediastinit, in a trachea – to aspiration bronchial pneumonia. Spread of an infection to area of heart is accompanied by risk of emergence of a purulent perikardit. At formation of purulent zatek in a zone of vessels of a neck thromboses, infection of covers and tissues of a golony brain with the subsequent development of encephalitis and meningitis are possible. The heaviest complication of a purulent strumit is the sepsis interfaced to probability of a lethal outcome. In rare instances after a sharp bacterial tireoidit (usually – diffusion) the hypothyroidism is diagnosed.
At the initial stage patients usually address the therapist with complaints to pain and feeling of a raspiraniye, discomfort on a forward wall of a neck, difficulty when swallowing, the increased temperature, fever. At detection of infiltrate in a zone of a thyroid gland the doctor gives the direction on consultation to the endocrinologist. Suspicion on OGT arises at the expert at identification in the anamnesis of infectious diseases, such as sinusitis, tonsillitis, pneumonia and some other. For confirmation of the estimated diagnosis and differentiation of a sharp purulent form of a disease with a subsharp tireoidit, a sharp not purulent tireoidit, an autoimmune tireoidit, hemorrhage in gland and anaplastichesky cancer the next researches are conducted:
- Survey. At a palpation the painful, increased thyroid gland is determined by the forward surface of a neck. At a stage of infiltration of an inflammation the inflammation center dense, at a purulent raspravleniye and formation of abscess – softened. Skin is hyperemic. Lymph nodes on a neck are increased, painful. The general body temperature is increased.
- Laboratory tests. In the general blood test signs of inflammatory process are defined: high rates of neutrophils, shift of a leykogramma to the left, moderately accelerated SOE. For differential diagnostics of sharp and chronic forms of tireoidit carry out the test for the level of tireoidny hormones. At sharp process indicators remain normal.
- Ultrasonography of a thyroid gland. Ultrasonic scanning is carried out for the purpose of detection of abscess. According to a sonografiya existence of the ekhonegativny center (centers) – the site with liquid contents, the increased cervical lymph nodes comes to light. The obtained information is necessary for the solution of a question of carrying out surgical drainage.
- Biopsy of fabrics of gland. In doubtful cases the tonkoigolny aspiration biopsy is appointed. At material of a trial puncture of gland there is a pus. During the diagnostic procedure introduction of an antibiotic directly in the struck fabric is possible.
Treatment of a sharp purulent tireoidit
Patients are hospitalized in office of surgery, at the end of the sharp period go for out-patient observation to the endocrinologist. Treatment is aimed at elimination of the center of an infection, knocking over of heavy symptomatology and the prevention of the complications connected with danger of spontaneous opening of abscess. Integrated therapeutic approach includes three directions of medical care:
- Antibiotic treatment. In the beginning medicines of a broad spectrum of activity are appointed penicillin or tsefalosporina are, as a rule, used. When receiving contents of the purulent center the analysis on definition of sensitivity of flora to antibiotics for the subsequent choice of the most effective medicine is carried out.
- Dezintoksikatsionny and anti-inflammatory therapy. Antihistaminic medicines (H1 blockers - histamine receptors) antiserotoninovy means (blockers of serotoninovy receptors) are applied to decrease of the activity of inflammatory processes. The program of desintoxication includes intravenous injections of salt and plazmozameshchayushchy solutions, the intensive drinking mode.
- Drainage of a cavity of abscess. In the presence of the created cavity surgery is shown: abscess is opened, delete the damaged fabrics, establish a drainage on which purulent liquid is outside removed. The procedure is performed in early terms to warn a spontaneous rupture of an abscess and infection of surrounding fabrics.
Forecast and prevention
Sharp tireoidit the infectious nature does not break function of a thyroid gland and well gives in to therapy by antibiotics. Forecast of a disease favorable. Prevention is based on timely and adequate treatment of a sharp infection, regular sanitation of the chronic centers. It is regularly recommended to have examinations at the ENT specialist and the stomatologist, to observe hygiene of an oral cavity, throat, nose and ears, during the periods of epidemics of respiratory diseases to take the appropriate measures of precaution. At sharp infections it is necessary to observe strictly all appointments of the doctor, not to interrupt treatment independently even at improvement of health.