Thyroid abscesses (acute bacterial thyroiditis)

Absceses of the thyroid are rare in the developed world, but are not uncommon here in the developing world. The patient presents with a wide, very painful, oedematous swelling of his neck which is maximal over his thyroid. The pus is too deep for you to be able to detect fluctuation. Inflammatory oedema may be so marked as to cause Ludwig's angina (5.10).

THYROID ABSCESSES For the general method, see Section 5.2.

DIAGNOSIS. Confirm the presence of pus by needle aspiration.

ANAESTHESIA. Give the patient intravenous ketamine or a general anaesthetic with intubation. Local anaesthesia is not satisfactory, unless the pus is pointing, but if your anaesthetist is not expert, you may have to use it. If he is to have a general anaesthetic the anaesthetist must be experienced.

INCISION. Use a scalpel to make a transverse incision 5 cm or larger over the area of maximal swelling. Insert a haemostat and drain the pus by Hilton's method (5-3). Insert a drain and give him an antibiotic (chloramphenicol or a cephalosporin) for 5 days.