自发性出血性甲状腺囊肿在初级保健中表现为单侧疼痛性甲状腺炎：早期识别一种可能危及生命的并发症

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中文摘要

背景： 甲状腺结节内自发性出血是一种不常见但可能令人警惕的病症，表现为急性颈部疼痛、肿胀和压迫症状，可能威胁气道并带来诊断和管理挑战。
方法： 我们描述了一名35岁亚洲女性，她表现为突然发作的严重左侧颈部疼痛和肿胀，伴有吞咽困难和劳力性呼吸困难。无外伤史、抗凝药物使用史或既往甲状腺干预史。体格检查显示明显的单侧甲状腺压痛和肿胀，无明显气道受损。甲状腺功能检查在正常范围内。颈部超声显示左侧甲状腺一个复杂的混合性实性-囊性结节，大小为3.2 × 2.4 × 3.5 cm，内部有回声分隔，符合出血性甲状腺囊肿。初始采用非甾体抗炎药保守治疗，缓解甚微。患者随后接受短程高剂量口服皮质类固醇治疗，并接受超声引导下细针穿刺，抽出7 mL深褐色血性液体。细胞学检查显示以巨噬细胞为主的囊内容物，无恶性肿瘤证据。抽吸和类固醇治疗后症状显著改善。患者被转诊至内分泌科随访，并因潜在复发风险讨论了择期甲状腺半切除术。
结果： 甲状腺结节自发性出血虽然罕见，但在表现为急性单侧颈部疼痛和肿胀的患者中应考虑，即使没有可识别的危险因素。早期影像学检查、警惕的气道评估和个体化管理至关重要。在临床稳定的患者中，抽吸和皮质类固醇保守治疗可能有效，而手术干预应保留用于复发病例或存在气道受损的病例。
结论： 本病例强调了初级保健医生在早期识别和紧急转诊表现为急性颈部肿胀的罕见但可能危及生命的甲状腺疾病中的关键作用。

英文摘要

Spontaneous hemorrhage within a thyroid nodule is an uncommon but potentially alarming condition presenting with acute neck pain, swelling, and compressive symptoms that may threaten the airway and pose diagnostic and management challenges. We describe a 35-year-old Asian woman who presented with sudden onset of severe left-sided neck pain and swelling, accompanied by dysphagia and exertional dyspnea. There was no history of trauma, anticoagulant use, or prior thyroid intervention. Physical examination revealed marked unilateral thyroid tenderness and swelling without overt airway compromise. Thyroid function tests were within normal limits. Neck ultrasonography demonstrated a complex mixed solid-cystic left thyroid nodule measuring 3.2 × 2.4 × 3.5 cm with internal echogenic septations, consistent with a hemorrhagic thyroid cyst. Initial conservative management with non-steroidal anti-inflammatory drugs provided minimal relief. The patient was subsequently treated with a short course of high-dose oral corticosteroids and underwent ultrasound-guided fine-needle aspiration, yielding 7 mL of dark brown hemorrhagic fluid. Cytological examination revealed macrophage-predominant cyst contents with no evidence of malignancy. Significant symptomatic improvement was noted following aspiration and steroid therapy. The patient was referred for endocrinology follow-up, with elective hemithyroidectomy discussed due to the potential risk of recurrence. Spontaneous hemorrhage of a thyroid nodule, although rare, should be considered in patients presenting with acute unilateral neck pain and swelling, even in the absence of identifiable risk factors. Early imaging, vigilant airway assessment, and individualized management are crucial. In clinically stable patients, conservative treatment with aspiration and corticosteroids may be effective, while surgical intervention should be reserved for recurrent cases or those with airway compromise. This case highlights the critical role of primary care physicians in early recognition and urgent referral of rare but potentially life-threatening thyroid conditions presenting with acute neck swelling.