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Tattoli L, Sussetto L, Di Vella G. Traumatic hemorrhage of the thyroid as a work-related injury: a case report and review of the literature. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00688-1. [PMID: 37556050 DOI: 10.1007/s12024-023-00688-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
Traumatic hemorrhage of the thyroid gland resulting from blunt injury to the neck is a very rare event. Particular neck positions can expose the thyroid to trauma, especially in motor vehicle collisions, falls, direct blows, or sport activities. Preexisting conditions such as goiters, adenomas, and cysts can increase the risk of bleeding, reducing the force required to rupture the gland and make the thyroid more prone to injury. The authors report the case of a 53-year-old man who was involved in a fire while working on maintenance of a liquid petroleum gas (LPG)-powered car. He subsequently presented to the emergency department with painful swelling of his right anterior neck with a palpable mass. CT scan showed a right thyroid hemorrhagic cyst. The worker reported that he had jumped into the car trunk to extinguish the fire and covered the gas tank nozzle with his own body to prevent dispersal of the accelerant. In this case, the medico-legal evaluation was useful to delineate between natural and traumatic causes of the injury. Medico-legal assessment is key in understanding the dynamics involved in work-related events to identify any legal responsibilities of the worker or the employer.
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Affiliation(s)
- Lucia Tattoli
- Department of Public Health and Paediatrics, Section of Legal Medicine, University of Turin, Corso Galileo Galilei 22, 10126, Turin, Italy.
| | - Luca Sussetto
- Department of Public Health and Paediatrics, Section of Legal Medicine, University of Turin, Corso Galileo Galilei 22, 10126, Turin, Italy
| | - Giancarlo Di Vella
- Department of Public Health and Paediatrics, Section of Legal Medicine, University of Turin, Corso Galileo Galilei 22, 10126, Turin, Italy
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Zhang X, Gong P, Sheng L, Lin Y, Fan Q, Zhang Y, Bao Y, Li S, Du H, Chen Z, Ding C, Wang H, Xu P, Zhang M, Scalzo F, Liebeskind DS, Xie Y, Liu D. Prognostic value of subclinical thyroid dysfunction in ischemic stroke patients treated with intravenous thrombolysis. Aging (Albany NY) 2019; 11:6839-6850. [PMID: 31479421 PMCID: PMC6756908 DOI: 10.18632/aging.102215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/14/2019] [Indexed: 12/15/2022]
Abstract
Data regarding the association between subclinical thyroid dysfunction and clinical outcomes in ischemic stroke patients with intravenous thrombolysis (IVT) are limited. We aimed to investigate the predictive value of subclinical thyroid dysfunction in END, functional outcome and mortality at 3 months among IVT patients. We prospectively recruited 563 IVT patients from 5 stroke centers in China. Thyroid function status was classified as subclinical hypothyroidism, subclinical hyperthyroidism (SHyper) and euthyroidism. The primary outcome was END, defined as ≥ 4 point in the NIHSS score within 24 h after IVT. Secondary outcomes included 3-month functional outcome and mortality. Of the 563 participants, END occurred in 14.7%, poor outcome in 50.8%, and mortality in 9.4%. SHyper was an independent predictor of END [odd ratio (OR), 4.35; 95% confidence interval [CI], 1.86–9.68, P = 0.003], 3-month poor outcome (OR, 3.24; 95% CI, 1.43–7.33, P = 0.005) and mortality [hazard ratio, 2.78; 95% CI, 1.55–5.36, P = 0.003]. Subgroup analysis showed that there was no significant relationship between SHyper and clinical outcomes in IVT patients with endovascular therapy. In summary, SHyper is associated with increased risk of END, and poor outcome and mortality at 3 months in IVT patients without endovascular therapy.
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Affiliation(s)
- Xiaohao Zhang
- Department of Neurology, Jiangsu Provincial Second Chinese Medicine Hospital, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.,Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Pengyu Gong
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lei Sheng
- Department of Neurology, Jiangsu Provincial Second Chinese Medicine Hospital, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yanni Lin
- Department of Neurology, The First People's Hospital of Yulin, Yulin, Guangxi, China
| | - Qiqi Fan
- Department of Neurology, Jiangsu Provincial Second Chinese Medicine Hospital, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yun Zhang
- Department of Neurology, Mianyang Central Hospital, Mianyang, Sichuan, China
| | - Yuanfei Bao
- Department of Neurology, The Third People's Hospital of Nantong, Nantong, Jiangsu, China
| | - Shizhan Li
- Department of Neurology, The First People's Hospital of Yulin, Yulin, Guangxi, China
| | - Hongcai Du
- Department of Neurology, Mianyang Central Hospital, Mianyang, Sichuan, China
| | - Zhonglun Chen
- Department of Neurology, Mianyang Central Hospital, Mianyang, Sichuan, China
| | - Caixia Ding
- Department of Neurology, Jiangsu Provincial Second Chinese Medicine Hospital, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Huaiming Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Pengfei Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Min Zhang
- Department of Endocrinology, Nanjing Xianlin Drum Tower Hospital, Nanjing, Jiangsu, China
| | - Fabien Scalzo
- Department of Neurology, Neurovascular Imaging Research Core, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - David S Liebeskind
- Department of Neurology, Neurovascular Imaging Research Core, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Yi Xie
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Dezhi Liu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Shi L, Yan C, Xu W, Huang P. Acute diffuse and transient thyroid swelling after intravenous thrombolysis for acute ischemic stroke: A case report. Medicine (Baltimore) 2018; 97:e12149. [PMID: 30200109 PMCID: PMC6133473 DOI: 10.1097/md.0000000000012149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Intravenous thrombolysis is the primary therapy for acute ischemic stroke (AIS), but it has some complications, including symptomatic intracranial hemorrhage, orolingual angioedema, and extracranial bleeding. However, thyroid disorders associated with thrombolysis are very rare. PATIENT CONCERNS A 56-year-old man developed acute pain and neck swelling after thrombolysis with recombinant tissue plasminogen activator. DIAGNOSES Ultrasound revealed a diffusely enlarged thyroid with linear hypoechoic areas throughout the entire gland, resembling a "cracked" appearance. INTERVENTIONS The patient was treated conservatively with cold packs and observed closely. Follow-up ultrasound was made. OUTCOMES A few hours later, pain and swelling disappeared completely. A repeat ultrasound revealed complete recovery of thyroid volume and aspect on the next day. LESSONS After intravenous thrombolysis for AIS, several life-threatening complications, such as hemorrhage and orolingual angiedema, also can cause neck swelling. Urgent intubation and surgery may be required. However, the rare complication, acute diffuse thyroid swelling, is self-limiting and nonfatal and conservative treatment is sufficient. Neck ultrasound is helpful in rapidly distinguishing these complications.
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Gunasekaran K, Rudd KM, Murthi S, Kaatz S, Lone N. Spontaneous Thyroid Hemorrhage on Chronic Anticoagulation Therapy. Clin Pract 2017; 7:932. [PMID: 28243434 PMCID: PMC5304264 DOI: 10.4081/cp.2017.932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/25/2017] [Indexed: 11/23/2022] Open
Abstract
Even though highly vascularized, the thyroid gland rarely has spontaneous bleeding. Bleeding into the thyroid gland can result in potentially lethal acute airway compromise. This case report describes an elderly patient on warfarin for atrial fibrillation, who presented with swelling on the right side of her neck causing acute airway obstruction. An urgent computed tomography of the neck showed an enlarging hemorrhage into the right lobe of the thyroid gland. She was initially intubated for airway protection and her anticoagulation was reversed to stop the bleeding. She was closely monitored in the intensive care unit. After an uncomplicated tracheal extubation and recovery, she was discharged and scheduled for an elective total thyroidectomy. We desire that physicians be aware of this rare, potentially lethal bleeding complication.
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Affiliation(s)
- Kulothungan Gunasekaran
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA; Division of Hospital Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Kelly M Rudd
- Department of Pharmaceutical Care Services, Section of Clinical Pharmacy, Bassett Medical Center , Cooperstown, NY, USA
| | - Swetha Murthi
- Department of Internal Medicine, Sinai Grace Hospital , Detroit, MI, USA
| | - Scott Kaatz
- Division of Hospital Medicine, Henry Ford Hospital , Detroit, MI, USA
| | - Nazir Lone
- Department of Internal Medicine, Bassett Medical Center , Cooperstown, NY, USA
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Sahin S, Belice T, Ogullar S, Ayaz T, Cure E. Syncope in a patient with spontaneous hemorrhage into a thyroid nodule. Hippokratia 2014; 18:177-9. [PMID: 25336885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
BACKGROUND Spontaneous hemorrhage into a thyroid nodule occurs exceedingly rare and rarely a neck hematoma can develop. We report a case of syncope due to spontaneous hemorrhage into a thyroid nodule during anticoagulant and antithrombotic therapy. CASE PRESENTATION A 64-year-old man was transferred to the emergency department of our hospital because of syncope. His physical examination revealed a 7 x 5 cm hard and painless mass at the left neck region. The neck MRI confirmed a heterogeneous, hyperintense mass in the left lobe of thyroid compressing the trachea and left common carotid artery, internal jugular vein, and vagus nerve bundle. He did not require a surgery in the follow-up. As the hematoma underwent subtotal shrinkage, he remained well without syncope. CONCLUSION Hemorrhage into a thyroid nodule should always be considered in patients presenting with neurally mediated syncope.
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Affiliation(s)
- Sb Sahin
- > Department of Endocrinology and Metabolism Disease, Recep Tayyip Erdogan University Medical School, Rize, Turkey
| | - T Belice
- Department of Internal Medicine, Recep Tayyip Erdogan University Medical School, Rize, Turkey
| | - S Ogullar
- Department of Radiology, Recep Tayyip Erdogan University Medical School, Rize, Turkey
| | - T Ayaz
- Department of Internal Medicine, Recep Tayyip Erdogan University Medical School, Rize, Turkey
| | - E Cure
- Department of Internal Medicine, Recep Tayyip Erdogan University Medical School, Rize, Turkey
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