Acute and Subacute, and Riedel   s XXXX

@entity1 @entity32 @entity4941 @entity4 @entity8963 @entity221 @entity2348 @entity117 @entity1955 @entity1800 @entity74 @entity158 @entity1282 @entity5651 @entity370 @entity50 @entity1374
The thyroid, like any other structure, may be the seat of an acute or chronic suppurative or @entity32 . @entity74 may leave their mark on the thyroid gland as well as elsewhere. @entity8963 is a rare condition, usually the result of bacterial invasion of the gland. Its signs are the classic ones of @entity32 : heat, @entity158 , redness, and @entity4 , and special ones conditioned by local relationships, such as @entity1282 and a desire to keep the head flexed on the chest in order to relax the paratracheal muscles. The treatment is that for any febrile disease, including specific antibiotic drugs if the invading organism has been identified and its sensitivity to the drug established. Otherwise, a broad-spectrum antibiotic may be used. Surgical drainage may be necessary and a search for a @entity50 should be made, particularly in @entity1 with @entity1374 involving the left lobe. Important to differentiate from the acute @entity2348 of @entity8963 ( @entity8963 ) is subacute (granulomatous) @entity1374 ( @entity4941 ) which is far more common than @entity8963 and is characterized by a more protracted course, usually involving the thyroid symmetrically. The gland is also swollen and tender, and the systemic reaction may also be severe, with @entity221 and an elevated erythrocyte sedimentation rate. During the acute phase of the disorder, tests of thyroid function disclose a suppression of TSH, increased serum concentrations of T4, T3, and thyroglobulin while a diminished thyroidal RAIU is observed. The cause of @entity4941 has been established in only a few instances in which a @entity1800 has been the initiating factor. There may be repeated recurrences of diminishing severity. Usually, but not always, the function of the thyroid is normal after the disease has subsided. @entity4941 may be treated with rest, non-steroidal anti-inflammatory drugs or @entity117 , and thyroid hormone. If the disease is severe and protracted, it is usually necessary to resort to administration of glucocorticoids, but recurrence may follow their withdrawal. It is precisely the observational nature of @entity4941 therapy combined with the use of glucocorticoids which make it so critical to definitively rule out the bacterial etiology of @entity8963 in the @entity1 presenting with a @entity158 thyroid. Riedel   s @entity1374 is a chronic sclerosing replacement of the gland that is exceedingly rare. The process extends to adjacent structures, making any surgical intervention very difficult and potentially harmful. The exact cause of Riedel   s @entity1374 remains unknown, and no specific treatment is available beyond limited resection of the thyroid gland to relieve the symptoms of tracheal or esophageal compression. The use of anti-inflammatory medical treatments has been demonstrated to have significant benefits to outcome. @entity370 may involve the thyroid, and amyloid may be deposited in the gland in quantities sufficient to cause @entity5651 . In all of these diseases it may be necessary to give the @entity1 @entity1955 replacement therapy if the function of the gland has been impaired.
