Intrathyroid hemorrhage and acute upper airway obstruction after fine needle aspiration of the thyroid gland

Objectives: Although hematoma formation after fine needle aspiration (FNA) is the most commonly encountered complication, massive intrathyroid hemorrhage producing acute upper airway obstruction rarely occurs. Study Design: Case report. Methods. This case presented a 55-year-old woman with acute intrathyroid hemorrhage producing upper airway obstruction after diagnostic FNA of multiple thyroid nodules. Results. The patient underwent endotracheal intubation and subsequent total thyroidectomy because of rapid progression of airway symptoms. During operation, the thyroid gland showed a huge, edematous, firm swelling and intrathyroidal hemorrhage with no obvious actively bleeding vessels. Microscopic examination of the resected gland revealed bilateral multiple nodular hyperplasia and massive parenchymal hemorrhage with thin-walled, aberrantly enlarged vessels. Conclusion: Acute intrathyroid hemorrhage causing upper airway obstruction can develop after FNA of the thyroid. Prompt and adequate interventions are needed for patients with rapid progression of acute thyroid hemorrhage.