The associated factors for spontaneous intranodular hemorrhage of partially cystic thyroid nodules

Abstract

Spontaneous intranodular hemorrhaging in benign partially cystic thyroid nodules was reported to cause neck swelling, difficulty swallowing, and other oppressive symptoms attributed to their growing progressively at high rates. In our study, the risk factors for hemorrhaging in these nodules were investigated. We retrospectively analyzed benign partial cystic thyroid nodules from September 2017 to December 2019, and divided them into 2 groups according to the occurrence of intranodular hemorrhage. Age, gender, follow-up time nodules initial maximum diameter, blood supply, spongiform content, nodules solid components, and internal solid portion were compared between the 2 groups at the first ultrasound examination. Chi-Squared and multivariate analysis were performed to evaluate the association of hemorrhage with clinical and ultrasonographic characteristics. ROC analysis was performed to evaluate the utility of factors in predicting hemorrhage. There were 59 occurrences of intranodular hemorrhage, which were associated with abundant blood supply, spongiform contents, and unsmooth margin of the internal solid portion. After multivariate analysis, abundant blood supply, and spongiform content were independent predictors for hemorrhage. In ROC analysis integrating these predictors, the sensitivity was 62.7% and specificity was 95.2% with the AUC 0.881. Partially cystic thyroid nodules with abundant blood supply, non-smooth margin of the internal solid portion and a spongiform internal content were apt to spontaneous intranodular hemorrhaging, which can be recognized as soon as possible by ultrasound.

Management of a Spontaneous Thyroid Nodule Hemorrhage Causing Acute Airway Obstruction

“…ITH is relatively rare and the mechanism causing the hemorrhage is unknown. Some of the factors reported in the literature may be grouped as traumatic and nontraumatic causes ( 1 , 2 , 4 , 5 ). Blunt trauma to the anterior neck region or fine needle aspiration biopsy are responsible for most of the cases.…”

“…Even though increased intravascular pressure such as Valsalva maneuver, choking, constipation could be accepted as the etiological factors of spontaneous ITH, there is no consensus as to why hemorrhage occurs ( 3 ). Increased vascularization of the gland and more specifically arteriovenous shunting inside the nodule are thought to be the causal factors ( 2 , 4 , 6 , 7 ). In the presented case, increased intravascular pressure caused by vomiting could be the reason for ITH.…”

“…Thyroid gland hemorrhage is a life-threatening situation if not managed promptly and correctly. Spontaneous intrathyroidal hemorrhage (ITH) causing airway obstruction is relatively rare and different causes are reported in the literature ( 1 , 2 , 3 , 4 ). Spontaneous hemorrhage of the thyroid gland usually occurs in cases with thyroid nodules and cysts; however, the reason for rupture is still not clear ( 2 , 4 , 5 , 6 ).…”

“…Spontaneous intrathyroidal hemorrhage (ITH) causing airway obstruction is relatively rare and different causes are reported in the literature ( 1 , 2 , 3 , 4 ). Spontaneous hemorrhage of the thyroid gland usually occurs in cases with thyroid nodules and cysts; however, the reason for rupture is still not clear ( 2 , 4 , 5 , 6 ). We report a case with no known history of a thyroid disease that presented with an ITH causing severe airway obstruction as a life-threatening situation.…”

The New Era of TIRADSs to Stratify the Risk of Malignancy of Thyroid Nodules: Strengths, Weaknesses and Pitfalls

“…Nodules with a cystic or hemorrhagic component can evolve by shrinking. Risk factors for such evolution include abundant blood supply, non-smooth margin of the internal solid portion, and a spongiform internal content [56]. The process can be of variable length, sometimes lasting for years, but frequently leads to ambiguous US features mimicking malignancy.…”