Introduction: Spontaneous thyroid hematoma is a rare entity that can be favored by anticoagulation therapy. Any neck swelling can be life-threatening by compression of the upper aerodigestive tract and adjacent vascular axes.
Case report: We report the case of an 80-year-old patient with a previously existing goiter, started on vitamin K antagonists for atrial fibrillation, who presented to the emergency room for anterior neck mass that appeared 2 days before admission and rapidly expanding causing airway compromise. The presence of extensive bruising in both arms was suggestive of poisoning by vitamine K antagonists, the INR was at 7 with poorly tolerated anemia requiring blood transfusion. T4 at 40 pmol and TSH inhibited at 0.02 mIU/l with a positive CRP at 166 mg/l. CT showed a large nodular goiter associated with extensive diffuse infiltration of the thyroid gland with collections related to intrathyroid bleeding. The evolution was good under corticoid and antibiotic treatment with regression of the compressive signs. A thyroidectomy was performed one month later.
Discussion: Recent data from the literature report less than 50 cases of spontaneous cervical hematoma, almost half of which are iatrogenic (after anticoagulant therapy) and the thyroid origin of these hematomas is extremely rare. Pre-existing thyroid abnormalities, such as the existence of thyroid nodules may increase the risk of bleeding because of increased and altered vascularity. The treatment is based primarily on maintaining airway patency. Only 1/3 of the cases require surgical evacuation, more than half of the cases having a good response to conservative treatment.
Conclusion: The use of anticoagulant treatments is becoming more common. Bleeding of thyroid origin is rare but could be favored by the pre-existing nodules. This complication of anticoagulants deserves to be known because it can be life-threatening.
18 - 21 May 2019
European Society of Endocrinology