An Adolescent with Transient Hyperthyroxinemia after Blunt Trauma to Head and Neck

Abstract

Background. Thyroid storm is a well-known complication of surgical procedures in the lower neck, but is rare after a blunt neck trauma. The cases described previously have mainly focussed on adults with pre-existent thyroid disease. In this case report, we describe the disease course of a previously healthy adolescent who had asymptomatic hyperthyroxinemia after a blunt trauma of the jaw and neck. Case Presentation. A 17-year-old girl presented at our emergency department after she fell on her head while roller blading. On physical examination, among other injuries, she had a swelling in the lower neck, which appeared to involve the thyroid gland. Subsequent laboratory analysis was indicative of primary hyperthyroxinemia, with a free T4 of 59 pmol/L (reference range: 12–22) and a TSH of 0.46 mU/L (reference range: 0.5–4.3), but the patient had no symptoms fitting with this. Four weeks after the initial presentation, the patient reported only complaints regarding tenderness in the jaw and neck region. She was no longer hyperthyroidic on biochemical evaluation (with a free T4 level of 15.6 pmol/L and a TSH level of 0.33 mU/L), and antibodies against thyroid peroxidase or TSH receptor were not present. Conclusions. This case might indicate that hyperthyroxinemia following a neck trauma may go unnoticed if hyperthyroid symptoms are mild or absent and thyroid function tests are not performed.

Acute Thyrotoxicosis Following a Horse-Induced Neck Trauma

“…8) In several cases of trauma-induced thyroid hematoma, thyrotoxicosis occurs regardless of previous thyroid disease or hyperthyroid symptoms during the clinical course, and usually improves with a decreased extent of thyroid hematoma. 5,6,9) Previous reports demonstrated that focal hematoma and diffuse injury of the thyroid gland may cause destructive thyroiditis. 5,7) In this case, given that the area of the hematoma on the thyroid US showed decreased uptake on the thyroid scan, transient thyro- A previous case report showed that patients with thyroid trauma can experience a thyroid storm even in the absence of underlying hyperthyroidism.…”

Thyroid Rupture Secondary to Blunt Neck Trauma: A Case Report

“…3 Our patient suffered from direct, blunt trauma to the neck, but other similar injuries noted were penetrating neck injuries, vehicular accidents, assaults, sports-related injuries, and fine-needle aspiration. [1][2][3][4][5][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Occurring less commonly are those arising from indirect mechanisms such as straining from heavy physical activities, Valsalva from coughing or defecating, and deceleration injuries. 1,3,4 There have also been rare instances of spontaneous thyroid bleeding, but most were associated with preexisting thyroid pathology and chronic anticoagulation.…”

“…[3][4][5]9 Baseline thyroid hormone levels upon presentation and daily monitoring are recommended regardless if the patient is to be treated surgically or conservatively. [9][10][11][12] In low resource settings where thyroid hormone assays may not be readily available, the main features for a thyroid storm must be included in clinical status monitoring and must be managed accordingly to avoid its potentially fatal sequelae: fever, tachycardia or supraventricular arrhythmias, central nervous system symptoms, and gastrointestinal symptoms. 9,10 While approaches to diagnosis and management have been proposed, a consensus is yet to be made.…”