Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Boris D. Hristov, Robert Borrego, Patricia A. Harding, Dimiter B. Hristov
Department of Surgery, Brookdale Hospital Medical Center, Brooklyn, NY, USA
Am J Case Rep 2016; 17:192-195
Spontaneous goiter hemorrhage is a rare entity that can lead to life-threatening respiratory compromise. Goiter hemorrhages are usually due to effects of anticoagulation or neoplastic processes. The hormonal effects of pregnancy may also lead to such life-threatening goiter hemorrhages in the immediate postpartum period.
CASE REPORT: We report the case of a 36-year-old woman who complained of progressive neck swelling as well as eventual shortness of breath in the immediate postpartum period. Computed tomography scans and ultrasound of the neck revealed an enlarged and heterogenous thyroid with airway compression. The patient underwent an emergent subtotal thyroidectomy to alleviate the mass effect on the airway. Upon resection, the thyroid was noted to contain a goiter hemorrhage with no signs of neoplastic degeneration on pathology.
CONCLUSIONS: Pregnancy is a known hormonal stressor that routinely increases the size of the thyroid and also predisposes patients to goiter formation. In rare cases, thyroid goiters may be predisposed to hemorrhage, causing airway obstruction and necessitating urgent surgical intervention.
Keywords: Airway Obstruction - surgery, Adult, Goiter - surgery, Hemorrhage - surgery, Puerperal Disorders - surgery, Thyroid Diseases - surgery, Thyroidectomy