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Case Reports
. 2017 Nov 28;17(1):115.
doi: 10.1186/s12893-017-0322-y.

Thyroid gland hemorrhage after blunt neck trauma: case report and review of the literature

Johannes Lemke  1 , Markus N Schreiber  2 , Doris Henne-Bruns  1 , Gregor Cammerer  1 , Andreas Hillenbrand  3
Affiliations
Case Reports

Thyroid gland hemorrhage after blunt neck trauma: case report and review of the literature

Johannes Lemke et al. BMC Surg. .

Abstract

Background: Thyroid hemorrhage is considered to be an uncommon complication following blunt trauma to the neck. This condition is potentially life-threatening due to airway compression and may therefore require emergency airway management and surgical intervention in some cases.

Case presentation: We present the case of a 52-year-old woman who experienced a traumatic thyroid gland rupture (right lobe) with subsequent active arterial bleeding from branches of the inferior thyroid artery. On the same day, the patient presented to our emergency department with a painful swelling of the neck with an inspiratory stridor and hoarseness a few hours after a cycling accident. A right hemithyroidectomy was performed. The postoperative course was uneventful. We identified 33 additional cases published in English literature within the last 30 years, reporting blunt trauma to the neck with hemorrhagic complication of the thyroid gland. We provide a systematic review and particularly consider the aspects of endocrine surgery.

Conclusion: The treatment approach for patients with blunt thyroid trauma should be dependent on the extent of the thyroid injury. Patients with tracheal compression, active bleeding and increasing hoarseness/shortness of breath require emergency airway control and often surgical exploration for hemorrhage control followed by resection of the ruptured thyroid. Importantly, in contrast to routine thyroid surgery, no electromyographic endotracheal tube is used during emergency intubation. Exchange of an endotracheal tube should be carefully evaluated due to difficult airway management in this setting. For protection against double-sided recurrent nerve palsy and postoperative hypoparathyroidism, a unilateral approach is preferable whenever possible.

Keywords: Blunt neck trauma; Surgery; Thyroid gland hemorrhage.

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Conflict of interest statement

Ethics approval and consent to participate

Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

Consent for publication

Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

Competing interests

The authors declare no conflict of interests.

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Figures

Fig. 1
Fig. 1
Contrast-enhanced computed tomography revealed a laceration of the right thyroid lobe with diffuse hematoma
Fig. 2
Fig. 2
Algorithm for management of thyroid gland injury (based on the algorithm proposed by Heizmann et al.). Classification of Blunt Thyroid Injuries Grade Description of the Lesion by Heizmann: I Small parenchymal lacerations, bleeding into nodules, subcapsular hematoma. II Rupture of the thyroid gland with / without parathyroid hematoma. III Rupture of the thyroid gland with significant neck hematoma including tracheal compression. IV Rupture of the thyroid gland and neck hematoma with associated lacerations to the larynx skeleton and/or to carotid and jugular vessels
See this image and copyright information in PMC

References

    1. Park CH, KK O, Kim EK, Kim MJ, Jeong J, Son EJ. Thyroid gland rupture after blunt cervical trauma. J Ultrasound Med. 2006;25:943–946. doi: 10.7863/jum.2006.25.7.943. - DOI - PubMed
    1. Weeks C, Moore FD, Jr, Ferzoco SJ, Gates J. Blunt trauma to the thyroid: a case report. Am Surg. 2005;71:518–521. - PubMed
    1. Heizmann O, Schmid R, Oertli D. Blunt injury to the thyroid gland: proposed classification and treatment algorithm. J Trauma. 2006;61:1012–1015. doi: 10.1097/01.ta.0000238621.83780.e0. - DOI - PubMed
    1. Blaivas M, Hom DB, Younger JG. Thyroid gland hematoma after blunt cervical trauma. Am J Emerg Med. 1999;17:348–350. doi: 10.1016/S0735-6757(99)90083-9. - DOI - PubMed
    1. Chartier LB, Turner JP. Delayed intrathyroidal hematoma causing respiratory distress after a seemingly benign fall: a case report. Int J Emerg Med. 2010;3:431–433. doi: 10.1007/s12245-010-0196-6. - DOI - PMC - PubMed