Key result
Administration of tissue plasminogen activator for acute ischemic stroke caused thyroid cyst hemorrhage and acute airway compromise in a patient with an undiagnosed thyroid goiter.
Case Report (n=1)
Therapeutic administration of tPA for acute ischemic stroke can lead to life-threatening hemorrhage into an undiagnosed thyroid goiter, requiring emergent surgical airway decompression.
Alerts clinicians to rare tPA-related goiter hemorrhage in stroke; hypothesis-generating for pre-thrombolysis thyroid screening.
The risk of hemorrhage after therapeutic administration of tissue plasminogen activator (tPA) is well known. Cases of postadministration hemorrhage have been reported within many organ systems. We present a case of a 62-year-old female with undiagnosed thyroid goiter who received tPA for acute ischemic stroke and developed acute airway compromise. The surgical airway response team was called due to inability to ventilate or intubate. An incision into the mass during attempted tracheotomy released colloid and blood, decompressing the airway and facilitating ventilation and intubation. Hemithyroidectomy for mass removal was delayed for 3 days to allow normalization of post-tPA coagulopathy.
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Gallant et al. (2014) conducted a case report in Acute ischemic stroke and undiagnosed thyroid goiter (n=1). Tissue plasminogen activator (tPA) was evaluated. Administration of tissue plasminogen activator for acute ischemic stroke caused thyroid cyst hemorrhage and acute airway compromise in a patient with an undiagnosed thyroid goiter.
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