Spontaneous thyroid hemorrhage management: a case report

Background: Thyroid nodules are encountered in 19–68% of the population and in most cases require observation due to the risk of malignancy. Spontaneous intrathyroidal hemorrhage is a rare phenomenon that occurs in case of trauma or ulceration of a large vessel. The management of this patient group depends, first of all, on the severity of bleeding and airway obstruction. In order to assess the degree of compression provided by surrounding tissues, the most optimal method is ultrasonography. Decompression can be performed by ultrasound-guided puncture or drain placement in case of fluid collection. In most cases, bleeding stops with the use of conventional therapy. In case of dyspnea, an increase in the neck size and volume of hematoma, hemodynamic instability, an emergency intubation and surgical intervention is indicated. Case Description: This clinical case provides an example of spontaneous hemorrhage into a thyroid cyst with airway obstruction, which required surgical treatment. A 42-year-old female first began to notice pain in the neck and a nodule on the right since September 1, 2022. On September 7, 2022, she noted acute worsening of her neck pain, increase in the nodule size and she was urgently hospitalized. During neck examination there was a mass on the right, with the size of 6 cm × 8 cm, between the clavicle and the hyoid bone. She was closely monitored but due to the rapid increase in the cyst volume, pain sharpening, compression of surrounding tissues and dyspnea Medical Research Council (MRC) dyspnea scale 3, we decided to perform right-sided hemithyroidectomy. Conclusions: Spontaneous hemorrhage into the thyroid gland is a rare phenomenon that occurs when a feeding vessel rupture or erosion of a thyroid mass occurs. Mostly, it has good prognosis and requires conservative therapy and observation. Rarely, active bleeding can cause airway obstruction, requiring urgent intubation and emergency surgery.