Acute Spontaneous Hemorrhagic Degeneration of the Thyroid Nodule with Subacute Thyroiditis-Like Symptoms and Laboratory Findings.

Abstract

Abstract.Seventeen consecutive patients (3 men and 14 women, aged 14-75 years) with a hemorrhagic degeneration of the thyroid nodule, which was confirmed by both ultrasonography and either reddish or brown fluid evacuated by fine-needle aspiration, were classified as either acute type with an episode of abrupt painful swelling of the thyroid (n=4), or chronic type in which a painless thyroid nodule was incidentally found (n=13). One of the four acute type patients demonstrated subacute thyroiditis-like symptoms and laboratory findings including transient painful thyrotoxicosis associated with high serum levels of thyroid hormones and thyroglobulin (Tg), a suppressed serum TSH level, a low thyroidal radioactive iodine uptake (RAIU), and an accelerated erythrocyte sedimentation rate (ESR). In the other three acute type patients the serum level of Tg increased markedly, the serum thyroid hormones level increased in one, the thyroidal RAIU was low in two, and the ESR was accelerated in one. In the thirteen chronic type patients, the serum levels of the thyroid hormones and the thyroidal RAID were within the normal range, and few inflammatory signs were observed. These findings suggest that acute hemorrhagic degeneration of the thyroid nodule may thus cause transient subacute thyroiditis-like symptoms and laboratory findings.

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

“…[ 21 ] Bleeding into the gland can cause a sudden release of preformed thyroid hormones leading to acute hyperthyroidism. [ 9 22 23 24 25 ] This rare cause of destructive hyperthyroidism is usually self-limiting and does not require any treatment. However, most patients require emergency thyroidectomy and eventually develop hypothyroidism.…”

Acute Increase in Goiter Size During a Normal Pregnancy: An Exceptional Case Report

“…To the best of our knowledge, similar cases have not yet been reported, although less dramatic increases in goiter size can frequently be observed during pregnancy, especially in areas with moderate to severe iodine deficiency (12,13). In nonpregnant patients, there has only been one publication on patients presenting with acute spontaneous hemorrhagic degeneration of thyroid nodules resembling episodes of subacute thyroiditis (14).…”

Clinical course of acute hemorrhagic infarction of a thyroid nodule

“…Solid "hot" nodules became cystic "cold" nodules; marked regression was found in the nodule size; and nodular autonomous secretory activity was marked reduced. 4 Mizokami et al 7 reported that acute hemorrhagic degeneration of a thyroid nodule produced transient, subacute, thyroiditis-like symptoms and characteristic laboratory findings, including (1) a thyroid mass with tenderness that appeared abruptly without previous trauma; (2) such systemic symptoms as fever; (3) a mixed solid and cystic mass with wandering sludge on ultrasonography; (4) either a dark brown or dark red cystic fluid evacuated by fine-needle aspiration; (5) transient increase in serum thyroid hormones and thyroglobulin; (6) accelerated erythrocyte sedimentation rate (ESR) and positive C-reactive protein assay; (7) low thyroid uptake of radioactive iodine; (8) negative antithyroid autoantibody; and (9) disappearance of pain within 3-10 days.…”