Thyroid storm triggered by thyroid nodule fine needle aspiration biopsy: a case report

Area of Science:

• Endocrinology
• Nuclear Medicine
• Surgical Pathology

Background:

• Thyroid storm is a critical thyrotoxicosis complication triggered by various events.
• Patients with hyperthyroidism and multinodular goiter (MNG) require imaging before fine needle aspiration (FNA).
• Radionuclide thyroid scans are crucial for evaluating hyperfunctioning thyroid nodules.

Observation:

• A 62-year-old female with MNG and Graves' disease developed thyrotoxicosis.
• Imaging revealed enlarged thyroid lobes and tracheal narrowing.
• Fine needle aspiration (FNA) of a thyroid nodule preceded the onset of thyroid storm.

Findings:

• Fine needle aspiration (FNA) is infrequently indicated for hyperfunctioning thyroid nodules, identifiable via radionuclide scan.
• Achieving a euthyroid state is essential before performing FNA.
• Emergent total thyroidectomy was required for this patient due to thyroid storm.

Implications:

• This case highlights the risks associated with FNA in hyperfunctioning thyroid nodules.
• Radionuclide imaging should precede FNA in patients with MNG and hyperthyroidism.
• Prompt surgical intervention may be necessary in emergent hyperthyroid states.