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Intrathyroidal Hematoma, Biphasic Thyroid Dysfunction, and Permanent Hypothyroidism After Fine Needle Aspiration
Mohammad Jay1, Rebecca B K Wong2, Cristina Goens1
1Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Background/Objective:
Fine-needle aspiration (FNA) biopsy is a standard and generally safe procedure for evaluating thyroid nodules. Minor complications such as local pain or small hematomas are relatively common; however, large intrathyroidal hematomas and associated thyroid dysfunction are exceedingly rare.
Case Report:
We report the case of a 37-year-old woman who developed acute neck pain and swelling 1 week after FNA of a right thyroid nodule. Imaging revealed a large intrathyroidal hematoma extending across the isthmus. Thyroid function testing showed transient thyrotoxicosis followed by severe hypothyroidism, requiring long-term levothyroxine replacement. The patient had no history of bleeding disorders, anticoagulant or antiplatelet use, and experienced no procedural difficulties at the time of biopsy.
Discussion:
This case illustrates a rare but clinically important complication of FNA, in which mechanical and inflammatory injury from a hematoma led to destructive thyroiditis and permanent thyroid failure.
Conclusion:
Awareness of this potential complication, even among low-risk individuals, highlights the importance of avoiding FNA if not indicated, counseling patients on postprocedure symptoms and monitoring thyroid function in those who develop pain or swelling after biopsy.
