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VOLUME 18 , ISSUE 12 ( December, 2014 ) > List of Articles

CASE REPORT

Acute airway obstruction due to spontaneous intrathyroid hemorrhage precipitated by anticoagulation therapy

Penchala Mittadodla, Laxmi Kokatnur, Mohan Rudrappa

Keywords : Airway obstruction, anticoagulation, hyperthyroidism, substernal goitre, thyroid hemorrhage

Citation Information : Mittadodla P, Kokatnur L, Rudrappa M. Acute airway obstruction due to spontaneous intrathyroid hemorrhage precipitated by anticoagulation therapy. Indian J Crit Care Med 2014; 18 (12):825-827.

DOI: 10.4103/0972-5229.146324

License: CC BY-ND 3.0

Published Online: 01-12-2014

Copyright Statement:  Copyright © 2014; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Acute airway compromise due to hemorrhage in of thyroid gland is a rare life-hreating condition. The increasing use of anticoagulants for various reasons is likely increased the occurrence of this this complication. We describe an elderly patient on anticoagulation for atrial fibrillation, which developed swelling on the right side of neck causing acute airway obstruction requiring emergency intubation for airway protection. Computed tomographic scan showed massive intrathyroid hemorrhage along with substernal extension. She had supratherapeutic INR which was appropriately corrected emergently. She underwent resection of the thyroid gland which showed multinodular goiter without any evidence of malignancy. Our case illustrates the rare but lethal bleeding complication of anticoagulants in critical anatomical area and we request physicians should be wary of similar conditions.


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  1. Huge intrathyroidal hematoma causing airway obstruction: A multidisciplinary challenge. Thyroid 2006;16:795-9.
  2. Outpatient Prescription Anticoagulants Utilization and Expenditures for the U.S. Civilian Noninstitutionalized Population Age 18 and Older. Statistical Brief #268. Agency for Healthcare Research and Quality; October, 2009.
  3. Spontaneous rupture with pseudoaneurysm formation in a nodular goiter presenting as a large neck mass. J Clin Ultrasound 2007;35:518-20.
  4. Bilateral thyroid hematomas after fine-needle aspiration causing acute airway obstruction. Thyroid 2008;18:567-9.
  5. Acute airway compromise secondary to traumatic thyroid hemorrhage. Arch Otolaryngol Head Neck Surg 1994;120:427-30.
  6. Thyroid gland hematoma after blunt cervical trauma. Am J Emerg Med 1999;17:348-50.
  7. Blunt trauma to the thyroid: A case report. Am Surg 2005;71:518-21.
  8. Acute airway obstruction by spontaneous hemorrhage into thyroid nodule. Indian J Otolaryngol Head Neck Surg 2011;63:387-9.
  9. Apathetic thyrotoxicosis due to hemorrhage into a hyperfunctioning thyroid nodule after excessive anticoagulation. South Med J 1985;78:609-11.
  10. Intrathyroid hemorrhage and acute upper airway obstruction after fine needle aspiration of the thyroid gland. Laryngoscope 2006;116:154-6.
  11. Emergency surgery for acute respiratory failure secondary to spontaneous thyroid hemorrhage. Int Surg 2008;93:158-62.
  12. Management of airway compromise following thyroid cyst hemorrhage after thrombolytic therapy. Laryngoscope 2014.
  13. Emergency total thyroidectomy due to non traumatic disease. Experience of a surgical unit and literature review. World J Emerg Surg 2012;7:9.
  14. Prevalence and Geographical Distribution of Endemic Goiter. WHO Pulication Monogram 44. 2003. [AOI:6276176]. Available from: http://www.whqlibdoc.who.int/monograph/WHO_MONO_44_(p27)_(part1).pdf. Last accessed in July 15 th 2014.
  15. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol 2013;112:1142-7.
  16. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-51.
  17. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011;365:883-91.
  18. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011;365:981-92.
  19. Bleeding complications related to warfarin treatment: A descriptive register study from the anticoagulation clinic at Helsingborg Hospital. J Thromb Thrombolysis 2014;38:98-104.
  20. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 2005;3:692-4.
  21. The spectrum of emergency admissions for thyroidectomy. Am J Emerg Med 1999;17:591-3.
  22. Hemorrhage into a thyroid nodule as a cause of thyrotoxicosis. Endocr Pract 2006;12:299-301.
  23. A case of destructive thyrotoxicosis induced by neck trauma. Thyroid 2008;18:1333-5.
  24. Acute spontaneous hemorrhagic degeneration of the thyroid nodule with subacute thyroiditis-like symptoms and laboratory findings. Endocr J 1995;42:683-9.
  25. Toxic hematoma: An unusual and previously undescribed type of thyrotoxicosis. Thyroid 1995;5:129-32.
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