Intrathyroid Hemorrhage and Acute Upper Airway Obstruction after Fine Needle Aspiration of the Thyroid Gland

OBJECTIVES: Although hematoma formation after fine needle aspiration (FNA) is the most commonly encountered complication, massive intrathyroid hemorrhage producing acute upper airway obstruction rarely occurs. STUDY DESIGN: Case report. METHODS: This case presented a 55-year-old woman with acute intrathyroid hemorrhage producing upper airway obstruction after diagnostic FNA of multiple thyroid nodules. RESULTS: The patient underwent endotracheal intubation and subsequent total thyroidectomy because of rapid progression of airway symptoms. During operation, the thyroid gland showed a huge, edematous, firm swelling and intrathyroidal hemorrhage with no obvious actively bleeding vessels. Microscopic examination of the resected gland revealed bilateral multiple nodular hyperplasia and massive parenchymal hemorrhage with thin-walled, aberrantly enlarged vessels. CONCLUSION: Acute intrathyroid hemorrhage causing upper airway obstruction can develop after FNA of the thyroid. Prompt and adequate interventions are needed for patients with rapid progression of acute thyroid hemorrhage.