What is the most likely bronchial system anomaly in a child with recurrent subacute thyroiditis?

From the Guidelines

The most likely bronchial system anomaly in a child with recurrent suppurative thyroiditis is not directly related to the bronchial system, but rather a pyriform sinus fistula, which is a congenital abnormality connecting the hypopharynx to the thyroid gland. This condition is characterized by a persistent tract that serves as a pathway for bacteria to reach the thyroid gland, leading to recurrent infections 1. The symptoms of pyriform sinus fistula include neck pain, swelling, fever, and sometimes dysphagia during acute episodes.

Key Points to Consider

• The diagnosis of pyriform sinus fistula is typically confirmed with a barium swallow study or CT scan with contrast.
• Management involves antibiotics for acute infections, followed by complete surgical excision of the fistula tract to prevent recurrence.
• Without definitive surgical treatment, these children will continue to experience repeated episodes of thyroid infection.
• The embryological basis for this anomaly relates to the development of the third and fourth branchial pouches, with incomplete obliteration of these structures leading to the persistent fistulous tract.

Important Considerations

• The provided evidence on flexible endoscopy of pediatric airways 1 does not directly address the relationship between bronchial system anomalies and recurrent suppurative thyroiditis.
• However, it highlights the importance of considering congenital anomalies in the evaluation of recurrent infections in children.
• A thorough diagnostic workup, including imaging studies, is essential to identify the underlying cause of recurrent suppurative thyroiditis.

From the Research

Bronchial System Anomalies and Thyroiditis

There is no direct evidence in the provided studies to suggest a specific bronchial system anomaly that is most likely to occur in a child with recurrent separative thyroiditis.

Thyroiditis in Children

• Autoimmune thyroiditis (AIT) is the most common thyroid disorder in the pediatric age range 2.
• AIT may coexist with other organ-specific autoimmune diseases 2.
• The disease may occur rarely in children <1 year of life 2.
• Autoimmune thyroid diseases (AIT) are common in children and may present with a variety of signs and symptoms including: euthyroid goiter, hypothyroidism, or hyperthyroidism 3.

Clinical and Laboratory Findings

• Clinical data, laboratory and sonographical findings in 34 patients with autoimmune thyroiditis showed that palpable thyromegaly was present in 85% of patients 4.
• Symptoms had been present for a period between 6 weeks and 7.5 years: median in all patients 6 months, median in hypothyroid patients 9 months 4.
• At time of diagnosis 15 patients suffered from hypothyroidism, 3 from hyperthyroidism and 7 patients showed normal levels of thyroid hormones 4.

Treatment and Follow-up

• Patients with persistent hyperthyroidism were treated with carbimazol 4.
• During the follow-up period enlargement of the thyroid gland decreased in one third of the patients 4.
• Early recognition and treatment of the disease should be achieved for a preventive care of hypothyroidism 4.

There are no research papers to assist in answering the question about the most likely bronchial system anomaly in a child who gets recurrent separative thyroiditis.