Case Report: Suspected Rupture of a Papillary Thyroid Tumor in a Patient With Graves' Disease Who Experienced Airway...

This case report describes a 55-year-old woman presenting with acute dysphagia and neck swelling after a "popping" sensation in her neck. CT and MRI revealed a large retropharyngeal cystic mass and a left thyroid lobe mass, causing airway displacement. Despite significant effacement of the oropharyngeal and supraglottic airway on flexible nasopharyngolaryngoscopy, the patient remained asymptomatic regarding respiratory distress. Subsequent ultrasound-guided fine needle aspiration biopsy diagnosed malignant papillary thyroid carcinoma. Concurrently, previously undiagnosed Graves' disease was identified. The clinical presentation was attributed to suspected rupture or hemorrhage of the malignant thyroid tumor, leading to a serosanguineous fluid collection and inflammatory edema. The patient was managed with high-dose steroids and intravenous antibiotics, resulting in improved airway edema. She never developed stridor or dyspnea throughout her hospital course and later underwent a total thyroidectomy with neck dissection. This case highlights the potential for a thyroid malignancy to present with suspected spontaneous rupture or hemorrhage causing airway effacement and raises the question of whether Graves' disease, due to increased vascularity, put patients at additional risk of this presentation.