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Spontaneous Thyroid Hemorrhage on Chronic Anticoagulation Therapy

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ABSTRACT

Even though highly vascularized, the thyroid gland rarely has spontaneous bleeding. Bleeding into the thyroid gland can result in potentially lethal acute airway compromise. This case report describes an elderly patient on warfarin for atrial fibrillation, who presented with swelling on the right side of her neck causing acute airway obstruction. An urgent computed tomography of the neck showed an enlarging hemorrhage into the right lobe of the thyroid gland. She was initially intubated for airway protection and her anticoagulation was reversed to stop the bleeding. She was closely monitored in the intensive care unit. After an uncomplicated tracheal extubation and recovery, she was discharged and scheduled for an elective total thyroidectomy. We desire that physicians be aware of this rare, potentially lethal bleeding complication.

No MeSH data available.


Related in: MedlinePlus

Computed tomography scan showing diffusely enlarged heterogeneous (5.7×5.2×4.9 cm) thyroid extending into the superior mediastinum. There is a mass effect on the subglottic airway from the large heterogeneous thyroid goiter. A) Axial view; B) sagittal view.
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fig001: Computed tomography scan showing diffusely enlarged heterogeneous (5.7×5.2×4.9 cm) thyroid extending into the superior mediastinum. There is a mass effect on the subglottic airway from the large heterogeneous thyroid goiter. A) Axial view; B) sagittal view.

Mentions: Initial laboratory studies showed an INR of 2.0 (therapeutic goal 2.0-3.0), a thyroid stimulating hormone of 1.68 mIU/L (normal range 0.34-3.00 mIU/L), and a hemoglobin of 12.5 g/dL (normal range 11.5-15.5 g/dL). Chest x-ray showed cardiomegaly with mild pulmonary vascular prominence. In view of the worsening respiratory distress, urgent computed tomography of the neck was done, which showed an enlarged, heterogeneous thyroid gland, with a large (5.7×5.2×4.9 cm) heterogeneous nodule in the inferior right thyroid lobe consistent with an active intrathyroidal hemorrhage (Figure 1). The hemorrhage was causing mild mass effect on the subglottic trachea with substernal extension into the upper mediastinum. No bleeding into the retropharyngeal or parapharyngeal space was seen.


Spontaneous Thyroid Hemorrhage on Chronic Anticoagulation Therapy
Computed tomography scan showing diffusely enlarged heterogeneous (5.7×5.2×4.9 cm) thyroid extending into the superior mediastinum. There is a mass effect on the subglottic airway from the large heterogeneous thyroid goiter. A) Axial view; B) sagittal view.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5304264&req=5

fig001: Computed tomography scan showing diffusely enlarged heterogeneous (5.7×5.2×4.9 cm) thyroid extending into the superior mediastinum. There is a mass effect on the subglottic airway from the large heterogeneous thyroid goiter. A) Axial view; B) sagittal view.
Mentions: Initial laboratory studies showed an INR of 2.0 (therapeutic goal 2.0-3.0), a thyroid stimulating hormone of 1.68 mIU/L (normal range 0.34-3.00 mIU/L), and a hemoglobin of 12.5 g/dL (normal range 11.5-15.5 g/dL). Chest x-ray showed cardiomegaly with mild pulmonary vascular prominence. In view of the worsening respiratory distress, urgent computed tomography of the neck was done, which showed an enlarged, heterogeneous thyroid gland, with a large (5.7×5.2×4.9 cm) heterogeneous nodule in the inferior right thyroid lobe consistent with an active intrathyroidal hemorrhage (Figure 1). The hemorrhage was causing mild mass effect on the subglottic trachea with substernal extension into the upper mediastinum. No bleeding into the retropharyngeal or parapharyngeal space was seen.

View Article: PubMed Central - PubMed

ABSTRACT

Even though highly vascularized, the thyroid gland rarely has spontaneous bleeding. Bleeding into the thyroid gland can result in potentially lethal acute airway compromise. This case report describes an elderly patient on warfarin for atrial fibrillation, who presented with swelling on the right side of her neck causing acute airway obstruction. An urgent computed tomography of the neck showed an enlarging hemorrhage into the right lobe of the thyroid gland. She was initially intubated for airway protection and her anticoagulation was reversed to stop the bleeding. She was closely monitored in the intensive care unit. After an uncomplicated tracheal extubation and recovery, she was discharged and scheduled for an elective total thyroidectomy. We desire that physicians be aware of this rare, potentially lethal bleeding complication.

No MeSH data available.


Related in: MedlinePlus