Acute airway obstruction due to spontaneous intrathyroid hemorrhage precipitated by anticoagulation therapy

Abstract

Acute airway compromise due to hemorrhage in of thyroid gland is a rare life-hreating condition. The increasing use of anticoagulants for various reasons is likely increased the occurrence of this this complication. We describe an elderly patient on anticoagulation for atrial fibrillation, which developed swelling on the right side of neck causing acute airway obstruction requiring emergency intubation for airway protection. Computed tomographic scan showed massive intrathyroid hemorrhage along with substernal extension. She had supratherapeutic INR which was appropriately corrected emergently. She underwent resection of the thyroid gland which showed multinodular goiter without any evidence of malignancy. Our case illustrates the rare but lethal bleeding complication of anticoagulants in critical anatomical area and we request physicians should be wary of similar conditions.

Critical airway compression caused by a large mediastinal tumour with spontaneous haemorrhage

“…Interestingly, in the literature, we found only one case report that demonstrated spontaneous haemorrhage of substernal goitre. Kokatnur and colleagues reported a 73‐year‐old female with a history of arterial fibrillation on warfarin therapy, whose international normalized ratio was supra‐therapeutic at 3, presented with worsening respiratory distress that warranted emergency intubation due to haemorrhage in the thyroid gland with substernal extension 5. However, in our case, our patient has no underlying disease that may cause platelet dysfunction or coagulopathy, and she was not on any anticoagulant.…”

Spontaneous Thyroid Hemorrhage on Chronic Anticoagulation Therapy

“…The thyroid gland is a highly vascularized organ; however, spontaneous bleeding into the gland is rare and only a few cases have been reported. 1-7 Bleeding into this area can lead to sudden, life-threatening airway compromise by tracheal compression. Preexisting benign conditions such as a goiter, nodule, and cyst can increase the vascularity of the gland and may increase the vulnerability for bleeding.…”

“…Preexisting benign conditions such as a goiter, nodule, and cyst can increase the vascularity of the gland and may increase the vulnerability for bleeding. 1 Anticoagulation treatment may potentiate the severity of spontaneous bleeding, including bleeding into a goiter. We describe a rare cause of acute airway obstruction secondary to spontaneous thyroid hemorrhage in the context of anticoagulant therapy with warfarin.…”

A Case of Spontaneous Postpartum Thyroid Hemorrhage Leading to Upper Airway Obstruction

“…Spontaneous thyroid hemorrhage is an extremely rare condition with few documented cases in the literature [ 1 – 4 ]. The few cases noted have been attributed either to anticoagulation [ 1 , 2 ], anaplastic thyroid cancer [ 4 ], or vascular rupture [ 4 ]. Acute airway compromise is a possible life-threatening complication of such a hemorrhage and warrants urgent intervention [ 1 , 3 , 4 ].…”

“…The few cases noted have been attributed either to anticoagulation [ 1 , 2 ], anaplastic thyroid cancer [ 4 ], or vascular rupture [ 4 ]. Acute airway compromise is a possible life-threatening complication of such a hemorrhage and warrants urgent intervention [ 1 , 3 , 4 ]. None of the cases previously described in the literature directly relate to pregnancy or the immediate post-partum period.…”