Acute Transient Thyroid Swelling Research Articles

Important Role of Ultrasonography Immediately After Fine-Needle Aspiration Biopsy of Thyroid Nodules to Detect Acute Transient Thyroid Swelling.

We aimed to determine whether early detection of acute transient thyroid swelling (ATTS) is possible using ultrasonography (US) surveillance immediately after fine-needle aspiration biopsy (FNAB) and discuss the usefulness of routine US after FNAB. We retrospectively evaluated the incidence, clinical features, and US and computed tomography findings of ATTS in patients with thyroid nodules who underwent FNABs at our hospital. The study period was divided into two time periods: only symptomatic patients after FNAB were examined using US in the first period (period A: January 2016 to November 2020), whereas all patients were routinely examined using US shortly after FNAB in the second period (period B: December 2020 to December 2022). We found that the frequency of ATTS increased from 0.18% (10/5,685) in period A to 1.58% (31/1,958) in period B because the majority of ATTS cases in period B were asymptomatic. Follow-up US performed 15 minutes to 3 hours later confirmed no exacerbation of thyroid swelling in patients diagnosed with ATTS during period B. Routine US examinations, shortly after FNAB, significantly reduced the number of return visits after discharge (from 5/10 to 2/31, p=0.006). Furthermore, the incidence of unilateral swelling was higher than previously reported. Routine US examinations shortly after FNAB may be useful in identifying ATTS regardless of the presence of symptoms; moreover, they may reduce patients' return visits after leaving the hospital. It is also important to inform patients that delayed complications are possible and that severe cases, although rare, do exist.

MON-479 Acute Thyroid Edema: A Rare Complication of Thyroid Fine Needle Aspiration

Background: Acute thyroid swelling is a rare complication of thyroid fine needle aspiration (FNA). The first documented case was in 1982 and to date there are less than 20 cases currently reported in the literature (1). Case Presentation: A 66-year-old female with a history of non-ischemic cardiomyopathy and heart failure was admitted to hospital to expedite heart transplant evaluation. A neck ultrasound was performed due to voice hoarseness and concern for vocal cord nodules. The ultrasound showed a 1.3 cm hypoechoic nodule in the right thyroid lobe. Given that the nodule had irregular borders and microcalcifications, a thyroid FNA was recommended.The patient’s home warfarin had been held for at least three days prior to the biopsy and her INR on the procedure date was 1.4. Her heparin drip was held four hours prior to the thyroid FNA. Immediately following the procedure, a 3.2 cm hematoma formed inferior to the thyroid gland. The heparin drip was restarted 6 hours post-FNA as per radiology’s recommendation. Cytology of the nodule was benign.The patient recovered well post FNA and improvement in the hematoma was noted on exam. Her hemoglobin was stable and she was restarted on warfarin. On day two post thyroid FNA, she reported significant neck pain, with no corresponding increase in the extra-thyroidal hematoma. No stridor or other concerning features were present on exam. A repeat thyroid ultrasound was performed three days after the FNA. It demonstrated fluid filled ‘cracks’ within the thyroid parenchyma and tripling in the volume of the thyroid gland, concerning for diffuse edema. No heterogeneity or subcapsular thickening was seen to suggest hemorrhage, and the previously demonstrated 3.2 cm extra-thyroidal hematoma was not visualized.She was treated with ibuprofen 800 mg and prednisone 30 mg, and noted an improvement in her neck pain with these measures. A repeat ultrasound done three weeks after initial thyroid FNA showed marked improvement of the diffuse swelling. Conclusion: The phenomenon of diffuse thyroid edema after fine need aspiration has been termed acute thyroid swelling (ATS). Given how frequently thyroid fine needle aspirations are performed, ATS appears to be a very rare complication. The etiology of ATS remains unknown, but the use of blood thinners, such as in our patient, does not appear to be a risk factor (1). The radiological appearance of fluid filled ‘cracks’ within the thyroid parenchyma suggests a more diffuse process, rather than a localized reaction. While NSAIDs or steroids may help with symptoms, patients appear to improve irrespective of whether or not medications are given. This suggests that ATS is a self-limiting condition without long term complications. Reference: (1) Polyzos SA, Anastasilakis AD, Arsos. Acute transient thyroid swelling following needle biopsy: An update. Hormones. 2012;11(2);147-150

Airway obstruction caused by acute transient thyroid swelling following fine needle aspiration biopsy of thyroid gland

Airway obstruction caused by acute transient thyroid swelling following fine needle aspiration biopsy of thyroid gland

Acute Transient Thyroid Swelling after Fine-needle Aspiration Biopsy: Case Report and Review of the Literature

Acute Transient Thyroid Swelling after Fine-needle Aspiration Biopsy: Case Report and Review of the Literature

Evanescent Hyperechoic Changes After Fine-Needle Aspiration Biopsy of the Thyroid in a Series With a Low Overall Prevalence of Complications.

The purpose of this study was to assess the frequency of and risk factors for fine-needle aspiration biopsy (FNAB)-related complications in Japanese patients with thyroid nodules evaluated by standard FNAB techniques. Six hundred fifty-three consecutive Japanese patients with 742 nodules who had undergone FNAB were enrolled. Nodule characteristics were evaluated, and thyroid volumes were measured. Fine-needle aspiration biopsy-related complications were identified on the basis of sonographic findings and patients' conditions after undergoing FNAB. Comparisons of patients' backgrounds and nodule characteristics were made between those with and without complications. The prevalence rates for FNAB-related complications, including acute transient thyroid swelling after FNAB and appearance of anechoic lesions, were 0.13% and 0.94%. In this study, we could not identify risk factors for FNAB-related complications. The sudden appearance of bright hyperechoic foci within the thyroid immediately after biopsy was reported as an FNAB-related unfamiliar appearance in 5 cases. Experimental FNA using resected porcine thyroid tissue suggested that the etiology of the hyperechoic appearance may be artificial air bubbles or reversed flow of aspirated fluid. Fine-needle aspiration biopsy-related complications are rare if preventive measures are performed and are not specific to Japanese patients with thyroid nodules. The sudden appearance of bright hyperechoic foci may be cause by contamination from air or fluid.

More on the acute transient thyroid swelling following needle biopsy

In response to the very interesting article that was published in Hormones 2012, 11(2): 147-150 “Acute transient thyroid swelling following needle biopsy: An update”, I would like to share our experiences regarding this phenomenon. We have had six such cases of acute transient thyroid swelling during ultrasound guided fine needle aspiration (FNA). All six cases occurred within a relatively short period of time (a few months, making us wonder if there is a seasonal variation on this side effect). The swelling in all six cases was limited to the nodule and the surrounding area. No swelling was observed on the opposite lobe or the prethyroid tissues. There was no neck echymosis or airway obstruction and the swelling was, in most of the cases, painless. In fact, only one female patient complained of moderate pain which probably was exacerbated by her anxiety. It is worth mentioning that all patients were given local anesthesia with a sc lidocaine injection. It is also clear that these swellings were not caused by hemorrhage, which could be easily excluded by ultrasound. Moreover, all patients were instructed not to take any aspirin, NSAIDs or antiplatelet agents for at least one week before the procedure. It is also our experience that this complication resolves, although all our patients but one were given hydrocortisone IV. Fifteen to thirty minutes later the swelling had substantially— although not completely — resolved and the patients were discharged without any further complication. A post FNA ultrasound was done in all six patients before they were discharged. This side effect does not appear to be age-dependent but it was more common in females, perhaps due to the fact that more women were submitted to this procedure. Nevertheless, our sample (of six patients) is rather too small to draw firm conclusions. At the beginning, we were definitely puzzled by this complication, since we were unable to explain it. Regarding the pathogenesis, our initial thoughts were that it was either some sort of idiosyncratic allergic reaction to the metallic needle or some kind of accidental contamination of the tissue via the needle with the gel we used for the probe. Finally, in one case in which we repeated the FNA six months later, we did not observe any repetition of this side effect. Interestingly, within the 10-year period during which FNAs have been performed in our private institute, we have encountered only these six cases, the last occurring almost 11 months ago.

Acute transient thyroid swelling after fine-needle aspiration biopsy: three cases during only 6 weeks - a rare complication?

Acute transient thyroid swelling after fine-needle aspiration biopsy: three cases during only 6 weeks - a rare complication?

Acute transient thyroid swelling following needle biopsy: An update

Address for correspondence: Stergios Polyzos, MD, MSc, PhD, 13 Simou Lianidi Str., 55134 Thessaloniki, Greece, Tel.: +3

Acute transient thyroid swelling after fine‐needle aspiration biopsy: rare complication of unknown origin

Acute transient thyroid swelling after fine‐needle aspiration biopsy: rare complication of unknown origin

Acute transient thyroid swelling after catheterization of the subclavian vein

Central venous catheters are frequently inserted for various indications. Insertion of a central venous catheter is not without risk; complications occur in more than 15% of the patients. Arterial puncture, hematoma, pneumothorax and hematothorax are among the most well-known and frequently reported complications. In this report, we present a remarkable case of acute diffuse edematous swelling of the thyroid gland as an unexpected and rare complication after attempted subclavian vein catheterization. Acute thyroid swelling rarely occurs after fine needle aspiration, and to our knowledge, we are the first to describe acute thyroid swelling after central venous catheter insertion.