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Background: Blunt thyroid trauma is rare but life-threatening in patients with pre-existing thyroid disease, as gland fragility increases risk of rupture and haemorrhage, potentially causing airway compromise. This report discusses a post-fall thyroid haemorrhage with airway threat in a patient with prior thyroid swelling, highlighting management and outcomes Case Presentation- A 65-year-old male with chronic goitre sustained thyroid haemorrhage following a fall. After unsuccessful conservative treatment, surgical exploration was performed involving debridement of necrotic right thyroid tissue (histopathologically confirmed as syringocystadenoma papilliferum) and near total thyroidectomy. DISCUSSION- Blunt injury to the thyroid gland is rare, but carries more risk in nodular/goitrous glands due to vascular fragility; contrast CT or MRI guides management, as seen in our patient requiring surgery for hematoma-induced airway threat. Histopathology revealed unprecedented thyroid syringocystadenoma papilliferum (typically a sweat gland tumour) with hemorrhagic necrosis alongside nodular goitre, highlighting trauma risks in glandular pathologies. CONCLUSION- This report describes an uncommon case of isolated thyroid trauma with haemorrhage into a pre-existing tumour necessitating surgical intervention. Management should be guided by radiological findings, with treatment ranging from conservative approaches to emergency surgery depending on airway stability and pathological findings.
Although blunt neck trauma is relatively common, blunt trauma causing thyroid gland injuries are rare. However, individuals with pre-existing thyroid conditions are more susceptible to thyroid gland rupture and haemorrhage. Thyroid haemorrhage is a rare but potentially life-threatening complication of blunt neck trauma. The accumulation of blood can lead to a rapidly expanding hematoma, which may compress the airway and cause respiratory distress. Prompt medical intervention, including securing the airway and possible surgical intervention, is crucial to prevent serious consequences.
Trauma to the thyroid gland encompasses both penetrating and blunt injuries, which can occur in incidents such as motor vehicle collisions, strangulation, falls, and physical assaults. Injuries are more common if there is pre-existing thyroid gland disease as the pre-existing thyroid abnormalities increase tissue fragility, making the gland vulnerable to rupture even from minor trauma2.
This case report documents an instance of thyroid gland haemorrhage leading to an impending airway compromise in a patient of pre-existing thyroid swelling resulting from a seemingly minor fall. We discuss the management and post-operative outcome as well as the nature of pre existing thyroid swelling.
A 65-year-old man presented to our emergency department following an alleged history of a fall where he struck his anterior neck on the ground. He had been initially treated at a local hospital with analgesics and referred to our institute. Patient arrived at our institute after 8 hours of trauma and on arrival, he remained alert and hemodynamically stable with normal vital signs (BP 150/100 mmHg, HR 84 bpm, RR 18/min) and adequate oxygenation (SpO₂ 96% on room air). Physical examination revealed significant neck swelling with ecchymosis and tenderness, more towards the right side but no subcutaneous emphysema, stridor, or respiratory distress. Notably, the patient developed immediate hoarseness post-trauma, with speech limited to whispering. Cervical spine radiographs showed left tracheal deviation without vertebral abnormalities. Breath sounds remained equal bilaterally, and auscultation detected no carotid bruits. The patient denied any episodes of aspiration or cough during the event. The patient had a history of pre-existing neck swelling for 20 years, for which he did not undertake any treatment.
Given the patient's stable respiratory and hemodynamic status (no distress, normal vitals), contrast-enhanced CT and magnetic resonance imaging was obtained. This revealed a multinodular goitre, where a large lobulated space-occupying lesion in the right lobe of thyroid had intralesional bleeding, with areas of necrotic changes, with small pseudoaneurysm within the posterior and inferior margin of the lesion. The feeding vessel could not be identified. Calcified nodule noted in the left lobe of thyroid.
Routine Blood investigations and the thyroid function tests and serum calcium levels came out to be normal. Patient was managed conservatively with intravenous antibiotics, tranexemic acid and steroids with strict airway monitoring. After two days of conservative management, patient developed breathing difficulty and progressive increase in pain along with stridor following which patient was taken for surgical exploration on day 3. .
During surgical exploration, hematoma and necrotic thyroid tissue noted involving the strap muscles and adherent to the right carotid sheath (with preserved right internal jugular vein and common carotid artery), which was carefully seperated and piecemeal removal of right tissues was done on right side and the left lobe of thyroid gland completely removed. Diffuse bleeding from the thyroid tissue bed necessitated intraoperative blood transfusions of 2 unit Packed Cells. Satisfactory hemostatsis with monopolar and bipolar cautery could not be achieved friable necrotic tissue adherent to the carotid sheath. The wound was closed with a negative pressure drain and haemocoagulase-soaked povidone-iodine ribbon gauze in place, which was progressively shortened 3rd and 4th post operative day and removed on 5th post operative day followed by regular antiseptic dressings and a two-week course of systemic antibiotic coverage. Intra-operatively, the right recurrent laryngeal nerve and parathyroid glands could not be visualized. Post operatively, the vocal cords were mobile bilaterally and the patient developed transient postoperative hypocalcemia, successfully managed with calcium gluconate infusions. Recovery was otherwise uncomplicated, with gradual resolution of hoarseness over one month of follow-up. Histopathology demonstrated syringocystadenoma papilliferum with haemorrhage in the right thyroid tissue, while the left gland showed nodular goitre with calcification. At the 4- and 6-month postoperative evaluations, the patient presented with persistent swelling in the right anterior neck region. Surgical intervention with total thyroidectomy was recommended to address this complication; however, the patient declined the procedure due to financial constraints. The patient remained biochemically euthyroid, with normal thyroid function test results at every follow-up visit.
While soft tissue injuries are common after blunt neck trauma, direct anterior impact may affect vessels, muscles, or aerodigestive or osteocartilagenous structures. Isolated thyroid injury, however, is exceedingly uncommon, occurring in merely 1–2% of cases3. Early case reports mainly described thyroid injuries in goitrous glands, where increased vascularity, gland enlargement, and capsular insufficiency raise bleeding risk. However, many cases now occur in patients with normal thyroid anatomy. Nodular changes enhance trauma vulnerability due to tissue fragility and hypervascularity, with critical symptoms appearing within 24 hours. Initial management focuses on securing airway/breathing/circulation (ABCs), followed by comprehensive injury assessment. While neck swelling is common, respiratory compromise doesn't always develop4
Contrast-enhanced CT is the diagnostic modality of choice for thyroid trauma, precisely identifying glandular ruptures, hematomas, and concomitant injuries to adjacent structures. In our patient, CT findings of a significant hematoma necessitated surgical intervention due to impending airway compromise. While ultrasound provides rapid evaluation of glandular integrity and fluid collections, CT offers a comprehensive assessment of surrounding tissues. Suspected vascular injuries require confirmatory angiography, and fiberoptic laryngoscopy remains essential for detecting CT-occult laryngotracheal trauma. Our patient maintained euthyroid status throughout the clinical course.
The histopathology results revealed syringocystadenoma papilliferum with haemorrhage in the right thyroid tissue, whereas the left thyroid gland exhibited nodular goitre with calcification. Syringocystadenoma papilliferum (SCAP) is an uncommon benign adnexal tumour of hamartomatous origin, typically derived from eccrine or apocrine sweat glands. However, there are no documented cases of SCAP occurring in thyroid tissue in standard histopathological literature. The primary treatment for SCAP is complete surgical excision5. Although no malignant features were identified in this case, the presence of the tumour in the thyroid could theoretically increase susceptibility to blunt trauma and significant haemorrhage due to the gland's vascular nature
Isolated thyroid gland injury is rare (<0.1% of trauma cases). We report a case of haemorrhage in pre-existing thyroid tumour warranting exploration. Contrast CT reveals extent of injury and disease guiding management. Stable patients may undergo conservative ICU care or hematoma evacuation, whereas instability demands immediate intervention. An algorithmic approach—factoring injury severity, tracheal compression, and thyroid pathology—optimizes individualized care.
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