Acute suppurative thyroiditis is a comparatively rare disease. Case reports have recently increased since we now know that a piriform sinus fistula is one of the causes of this disease. We have treated 7 patients with acute suppurative thyroiditis showing various clinical features. An echogram was useful in the diagnosis in a 2-year-old boy with a neck mass which we thought was a tumor. We could not find a piriform sinus fistula, although we searched carefully for one with fluoroscopy of the hypopharynx. About 1 year later we found the fistula with an esophagogram and removed it. Another patient who had been operated on 3 years earlier had a recurrence. We found the rest of the piriform sinus fistula with an esophagogram, and performed a reoperation. We present here 7 cases including these 2, and show the usefulness of ultrasonagraphy and of the determination of thyroglobulin in the diagnosis of acute suppurative thyroiditis. We stress that examination for a piriform sinus fistula and complete removal of the fistula are very important in patients with acute suppurative thyroiditis.
