Acute Suppurative and Subacute Thyroiditis: from Diagnosis to Management

Background: Acute Suppurative Thyroiditis (AST) and Subacute Thyroiditis (SAT) are two distinct inflammatory conditions of the thyroid gland with different clinical presentation, treatment and that recognize different causes. AST is a rare but serious bacterial infection, often associated with congenital anomalies in children, whereas SAT is a self-limiting, post-viral condition that causes temporary thyroid dysfunction. Methods: A comprehensive literature review was conducted using PubMed and UpToDate, including systematic reviews, meta-analyses, case series, and case reports. Studies focusing on epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment were selected, with special attention to pediatric cases. Results: AST accounts for fewer than 1% of thyroid diseases and is more common in children, with pyriform sinus fistulas being present in 21% of cases. It presents with fever, painful neck swelling, and complications such as abscess formation and airway obstruction. Early recognition and prompt management with broad-spectrum antibiotics, ultrasound-guided aspiration, or surgical drainage are crucial. In contrast, SAT can occur at any age but is most common in adult women and follows typically a viral infection. It presents with anterior neck pain and transient thyrotoxicosis and is generally managed with non-steroidal anti-inflammatory drugs or corticosteroids in severe cases. Accurate differential diagnosis is essential to prevent unnecessary interventions. Conclusions: Although rare, both AST and SAT require timely diagnosis and tailored treatment strategies to avoid complications. Advances in imaging and early detection of congenital anomalies have improved AST outcomes, while SAT remains a self-limiting condition that primarily requires symptom management. Further research is needed to better understand risk factors, pathogenesis, and optimal treatment approaches, particularly in pediatric populations and resource-limited settings.