Acute transient thyroid swelling following needle biopsy: An update

Polyzos, Stergios A.; Anastasilakis, Athanasios D.; Arsos, Georgios

doi:10.14310/horm.2002.1341

Cited by 15 publications

(18 citation statements)

References 15 publications

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“…Acute and transient thyroid swelling shows some characteristic ultrasonographic findings. The thyroid volume increased around 2-to 3-fold compared with the original volume, as previously reported (2,3). Characteristic hypoechoic "cracks" (crack-like appearance [5]) were observed in all of the present cases.…”

Section: Discussionsupporting

confidence: 85%

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Acute and Transient Thyroid Swelling Following Fine-Needle Aspiration Biopsy: Its Prevalence, Clinical Features, and Ultrasonographic Findings

Mizokami

Hamada

Maruta

et al. 2018

AACE Clinical Case Reports

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Objective: Acute diffuse swelling of the thyroid gland in the absence of hematoma formation is a rare complication following fine-needle aspiration biopsy (FNAB) that often resolves spontaneously. This complication has not been investigated in a large number of cases. Therefore, this study investigated the prevalence, clinical features, and ultrasonographic findings of acute and transient thyroid swelling after FNAB. Methods: We performed 16,817 FNABs for 9,596 thyroid nodules between 2011 and 2015. Results: We identified 10 patients (8 women and 2 men) with acute and transient thyroid swelling without significant hematoma. The biopsied nodules were multinodular goiter (likely adenomatous goiter; n = 7), solitary thyroid nodule (including one follicular adenoma; n = 2), and papillary carcinoma (n = 1). The thyroid glands enlarged by 1.3-to 4.7-fold, accompanied with anterior neck pain and/or swelling immediately after FNAB in five cases, 5 to 15 minutes after FNAB in two, and 1 to 2 hours after FNAB in three. Ultrasonography revealed dendritic hypoechoic lesions (hypoechoic "cracks") scattered throughout the swollen thyroid gland in all cases. Hypoechoic "cracks" did not show blood flow signal by color-flow Doppler imaging. Seven cases were treated with glucocorticoids, and three cases with smaller goiters were observed with neck cooling. Swelling of the thyroid gland subsided within several hours after symptom onset. Conclusion: The prevalence of acute and transient thyroid swelling was 0.10% (10 of 9,596 nodules). Hypoechoic "cracks" throughout the diffusely swollen thyroid gland were the ultrasonographic feature of this FNAB complication, despite pathologic differences in the biopsied nodules and different time intervals between FNAB and onset of acute thyroid swelling. (AACE Clinical Case Rep. 2018;4:e134-e139) Abbreviation: FNAB = fine-needle aspiration biopsy

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Section: Discussionsupporting

confidence: 85%

“…It is a self-limiting event that may appear following FNAB, but its pathogenesis remains to be elucidated. This rare complication of FNAB has been described as case reports or small case series (3,4), and there are no reports in large numbers of cases. We previously reported three cases with acute and transient thyroid swelling (5).…”

Section: Introductionmentioning

confidence: 99%

Acute and Transient Thyroid Swelling Following Fine-Needle Aspiration Biopsy: Its Prevalence, Clinical Features, and Ultrasonographic Findings

Mizokami

Hamada

Maruta

et al. 2018

AACE Clinical Case Reports

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“…Among them, 10 cases occurred after fine needle aspiration (FNA) and only 1 case occurred after subclavian vein catheterization. [ 6 – 8 ] All patients developed thyroid swelling during or within 2 hours after FNA or within a few minutes after the catheterization. Acute pain and neck swelling are the primary presentations.…”

Section: Discussionmentioning

confidence: 99%

Acute diffuse and transient thyroid swelling after intravenous thrombolysis for acute ischemic stroke

Shi

Yan²,

Xu³

et al. 2018

Medicine

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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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“…The most common adverse events include pain and local bleeding or hematoma and rarely result in infection [ 1 ]. Case reports in the literature describe acute or delayed (24 hour) swelling of the thyroid gland during or after fine needle aspiration [ 2 ]. The cases describe unilateral FNA but subsequent subacute (~4 weeks after procedure) diffuse gland swelling.…”

Section: Discussionmentioning

confidence: 99%

Thyroid Swelling and Thyroiditis in the Setting of Recent hCG Injections and Fine Needle Aspiration

Lamos

Munir

2016

Case Reports in Endocrinology

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A 60-year-old woman presented with a neck mass and underwent fine needle aspiration of a left thyroid nodule. During this time, she had been injected with hCG for weight loss. Soon after, she developed rapid diffuse thyroid growth with pain. She was ultimately diagnosed with thyrotoxicosis due to postaspiration subacute thyroiditis and subsequently became hypothyroid. This condition is rare in the nonpregnant state in noncystic nodules with a smaller needle gauge approach. The incidence of thyroid nodule discovery and evaluation is increasing. As more procedures are undertaken, understanding of potential complications is important. This case highlights potential complications of thyroid fine needle aspiration including diffuse thyroid swelling and thyroiditis. The role of hCG injections is speculated to have potentially stimulated thyroid follicular epithelium via cross-reactivity with the TSH receptor and contributed to the acute inflammatory response after fine needle aspiration.

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Acute transient thyroid swelling following needle biopsy: An update

Cited by 15 publications

References 15 publications

Acute and Transient Thyroid Swelling Following Fine-Needle Aspiration Biopsy: Its Prevalence, Clinical Features, and Ultrasonographic Findings

Acute and Transient Thyroid Swelling Following Fine-Needle Aspiration Biopsy: Its Prevalence, Clinical Features, and Ultrasonographic Findings

Acute diffuse and transient thyroid swelling after intravenous thrombolysis for acute ischemic stroke

Thyroid Swelling and Thyroiditis in the Setting of Recent hCG Injections and Fine Needle Aspiration

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