Features Useful in Differentiating Acute Suppurative Thyroiditis and Subacute Thyroiditis
| Characteristic | Acute Thyroiditis | Subacute Thyroiditis | |
|---|---|---|---|
| History | Preceding upper respiratory infection | 88% | 17% |
| Fever | 100% | 54% | |
| Symptoms of thyrotoxicosis | Uncommon | 47% | |
| Sore throat | 90% | 36% | |
| Physical examination of the thyroid | Painful thyroid swelling | 100% | 77% |
| Left side affected | 85+% | Not specific | |
| Migrating thyroid tenderness | Possible | 27% | |
| Erythema of overlying skin | 83% | Not usually | |
| Laboratory | Elevated white blood cell count | 57% | 25-50% |
| Erythrocyte sedimentation rate (>30 mm/hr) | 100% | 85% | |
| Abnormal thyroid hormone levels (elevated or depressed) | 5-10% | 60% | |
| Alkaline phosphatase, transaminases increased | Rare | Common | |
| Needle Aspiration | Purulent, bacteria or fungi present | ~100% | 0 |
| Lymphocytes, macrophages, some polys, giant cells | 0 | ~100% | |
| Radiological | 123I uptake low | Common | ~100% |
| Abnormal thyroid scan | 92% | Non-visualized | |
| Thyroid scan or ultrasound helpful in diagnosis | 75% | Non-specific | |
| Gallium scan positive | ~100% | ~100% | |
| 18F-FDG-PET | Positive | Positive | |
| Barium swallow showing fistula | Common | 0 | |
| CT scan useful | Varies | Not indicated | |
| Clinical Course | Clinical response to glucocorticoid treatment | Transient | 100% |
| Incision and drainage required | 85% | No | |
| Recurrence following operative drainage | 16% | No | |
| Pyriform sinus fistula discovered | 96% | No |
From: Acute and Subacute, and Riedel’s Thyroiditis
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