Inflammation of the thyroid is not of frequent occurrence. In the
several cases that the authors have seen there was some previous
enlargement of the organ, which probably caused a =lowered resistance=
of the local tissues. There is almost invariably some infection
elsewhere in the body. The exciting causes are usually streptococcus,
staphylococcus, or bacillus coli. The inflammation may follow
pneumonia, tonsillitis, rheumatism, typhoid, puerpal infections,
enteritis, diphtheria, influenza, mumps, etc. Trauma, carrying weights
on the head, and cold, may be etiological factors.
Commonly, one lobe is involved, though the entire gland may be
affected. There is swelling, the capsule is distended and painful, and
small hemorrhages occur which in the case of suppuration form the site
of the abscess. The swelling involves the parenchyma and interstitial
tissue.
The =onset= is usually sudden with chills, fever, and pain over the
glands. The patient keeps the head flexed to release the muscular
tension, swallowing is painful, and there is a sense of constriction.
A rapid heart may be a prominent symptom. Much depends at this period
on the =treatment= given. If the drainage can be freed, by lowering the
first ribs and raising the clavicles with attention to the dorsal and
cervical innervation, prompt subsidence of the condition commonly takes
place. This should be carefully accomplished in order not to bruise the
parts.
=Diagnosis= is not difficult as a rule. The symptoms and history of
infection will generally suffice. Hemorrhage may occur in a goiter and
somewhat simulate inflammation. A possibility of =malignancy= is to be
considered.
If the condition does not yield to treatment, surgical interference may
be necessary.
=Tuberculosis= and =syphilis= of the thyroid are rare conditions.
=Woody thyroiditis= may be mistaken for malignancy. The gland
is very fibrous, and when cut has a dry surface. The connective
tissue is hardened and crowds upon the parenchyma. This condition
is usually found in young men. It develops rapidly, with more or
less pain and dyspnea. =Adenocarcinoma=, =carcinoma=, and =sarcoma=
are rare diseases[106], still one should be on his guard as to
their possibility. They are most apt to occur after forty. A rapid
enlargement should be regarded with suspicion.