Management of a Spontaneous Thyroid Nodule Hemorrhage Causing Acute Airway Obstruction

Spontaneous intrathyroidal hemorrhage (ITH) causing airway obstruction is relatively rare. We report a case with no known history of a thyroid disease that presented with an ITH causing severe airway obstruction as a life-threatening situation. A 57-year-old female patient presented to the emergency department with sudden onset of swelling of the anterior neck, severe dyspnea, and unconsciousness. Computerized tomography scan after intubation revealed a 6.2x5.3 cm mass originating from the right thyroid lobe and compressing the airway. Drainage of hematoma with right lobectomy was done. When the patient was extubated one day after the surgery the vocal cords were found to be mobile. She was discharged after two days and there was no need for further intervention during the one-month follow-up. Spontaneous life-threatening ITHs are rare entities. Immediate assessment of airway obstruction and achieving a secure airway are crucial. Besides drainage of hematoma, thyroidectomy may also be necessary.