Acute Intrathyroidal Hematoma in a Multinodular Thyroid Presenting With Sudden Neck Swelling and Tracheal Deviation: A Case Report

Acute hemorrhage within the thyroid gland is uncommon but can cause rapid neck swelling and, in severe cases, airway compromise.We report a 65-year-old woman with hypertension and a history of partial thyroidectomy performed more than 25 years earlier who presented with painful neck swelling that developed overnight.The swelling was associated with pain on swallowing, without shortness of breath, voice change, drooling, fever, or recent neck trauma.She was hemodynamically stable with an oxygen saturation of 99% on room air.Examination showed marked neck swelling, thyromegaly, thyroid tenderness, and left-sided neck induration.Contrast-enhanced computed tomography (CT) demonstrated a multinodular thyroid with a large heterogeneous mass in the left thyroid lobe causing mass effect and rightward tracheal deviation.Subsequent ultrasonography demonstrated a heterogeneous intrathyroidal collection consistent with hematoma.The patient remained clinically stable and was discharged after approximately five hours of observation.At otolaryngology follow-up 10 days later, repeat ultrasonography showed a progressively enlarging left thyroid nodule, and fine-needle aspiration cytology was reported as a follicular neoplasm.She subsequently underwent total thyroidectomy without reported complications.Final pathology demonstrated thyroid follicular nodular disease (multinodular goiter), while gross examination of the left thyroid lobe identified a 5.5-cm hemorrhagic cyst, further supporting the diagnosis of intrathyroidal hemorrhage.This case highlights the importance of prompt airway assessment, imaging, and continued follow-up in patients with sudden thyroid enlargement, even when respiratory compromise is initially absent.