Sudden massive neck swelling due to hemorrhage of a thyroid adenoma: a case report

We report the case of a 71-year-old Caucasian man with sudden massive neck swelling due to intralesional bleeding of a thyroid adenoma. We present his clinical history, physical examination results, computed tomography (CT) scans, and histological findings after surgery. He presented with sudden massive swelling of the left side of his neck after sneezing while working with his hands over his head. An ear, nose, and throat examination showed a painless swelling of the left side of his neck and a displacement of his larynx to the right. CT scans revealed a mass originating from the left lobe of his thyroid gland and the mass displaced his larynx and trachea. A surgical exploration showed a greatly enlarged left lobe of his thyroid gland. A histopathological examination showed a hemorrhagic infarction of a follicular thyroid adenoma.Sudden intralesional bleeding of a thyroid adenoma is a rare condition but one that should be considered in cases of sudden and massive swelling of the neck.Follicular adenomas, arising from the thyroid follicles, are the most common benign tumors of the thyroid gland. They are more common in women than in men and occur in all age groups. Most adenomas are inactive and appear as cold nodules on scintigraphy images. However, autonomous adenomas, which can produce thyroid hormone without the regulation of thyroid-stimulating hormone, appear as hot nodules on scintigraphy images.As long as the patient is euthyroid, the clinical symptoms are limited to a palpable neck swelling that depends on the size of the adenoma. If hyperthyroidism develops, other typical clinical symptoms such as weight loss, hair loss, restlessness, palpitation, sweating, thirst, and diarrhea can be observed. If the blood supply to an adenoma is insufficient, the tumor can stop growing and involute. Adenomas can also become necrotic and calcified.A 71-year-old Caucasian man was admitted with sudden swelling of the left side of his neck to the emergency department of our