Int J Thyroidol.  2024 May;17(1):245-249. 10.11106/ijt.2024.17.1.245.

Acute Thyrotoxicosis Following a Horse-Induced Neck Trauma

• Lee J
• Jin M
• Yoo WS

• KMID: 2556518
• DOI: http://doi.org/10.11106/ijt.2024.17.1.245

Abstract

We present a rare case of acute thyrotoxicosis in a man with horse-induced neck trauma. A 60-year-old man presented to our emergency department with a head and neck injury caused by a horse kick. Computed tomography revealed a hematoma in the right thyroid gland. Ultrasonography of the neck revealed a 1.4 cm sized heterogenous hypoechoic lesion with an irregular margin in the right lower pole, suggestive of a thyroid hematoma. A thyroid function test revealed elevated free thyroxine and free triiodothyronine levels and suppressed thyrotropin levels. A Tc-99m thyroid scan showed a mild diffuse decreased uptake in the thyroid gland, especially in the right lower pole. We monitored the thyroid function test results, which took 2 months to recover to the normal range. This case indicates that awareness of thyroid dysfunction and monitoring of thyroid function are vital in patients with neck trauma.

Keyword

Thyroid; Neck trauma; Hematoma; Thyrotoxicosis

Figure

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  Fig. 1 Patient’s neck computed tomography (CT) shows hypoattenuation of the right thyroid gland with peri hemorrhagic fluid and adjacent soft tissue swelling. (A) Neck CT axial view. (B) Neck CT longitudinal view.

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  Fig. 2 Patient’s neck ultrasonography (US) during the treatment course. (A, B) Neck US transverse and longitudinal view show a heterogeneous hypoechoic mass of 1.4×0.7×1.2 cm in size at the right lower pole on Day 4 with anterior neck soft tissue swelling. (C, D) Neck US transverse and longitudinal view show a decrease in size (0.6×1.2× 0.75 cm) of the hypoechoic mass in the right lower pole with improvement of anterior neck soft tissue swelling after 2 months.

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  Fig. 3 Tc-99m pertechnetate thyroid scintigraphy showing decreased uptake in the right lower pole of the thyroid gland (arrow).

Reference

References

1. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016; 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 26(10):1343–421. DOI: 10.1089/thy.2016.0229. PMID: 27521067.

2. Delikoukos S, Mantzos F. 2007; Thyroid storm induced by blunt thyroid gland trauma. Am Surg. 73(12):1247–9. DOI: 10.1177/000313480707301211. PMID: 18186382.

3. Lemke J, Schreiber MN, Henne-Bruns D, Cammerer G, Hillenbrand A. 2017; Thyroid gland hemorrhage after blunt neck trauma: case report and review of the literature. BMC Surg. 17(1):115. DOI: 10.1186/s12893-017-0322-y. PMID: 29183351. PMCID: PMC5706149.

4. Ra YM, Lee SE, Choi IS, Choi WJ, Min HS, Yoon DS. 2010; A case of thyroid hematoma complicated with unexpected airway obstruction by blunt cervical trauma. Koreran J Endocr Surg. 10(1):39–41. DOI: 10.16956/kjes.2010.10.1.39.

5. Park CH, Oh KK, Kim EK, Kim MJ, Jeong J, Son EJ. 2006; Thyroid gland rupture after blunt cervical trauma. J Ultrasound Med. 25(7):943–6. DOI: 10.7863/jum.2006.25.7.943. PMID: 16798911.

6. Shin JH, Ji YB, Jeong JH, Lee SH, Tae K. 2015; Two cases of thyroid rupture after blunt cervical trauma. Ear Nose Throat J. 94(7):E21–3. DOI: 10.1177/014556131509400718. PMID: 26214674.

7. Peralta PMA, Yu JRT, Hernandez EF, Dela Fuente EB. 2022; Acute thyroiditis in a patient with neck trauma. Case Rep Psychiatry. 2022:6126254. DOI: 10.1155/2022/6126254. PMID: 36518904. PMCID: PMC9744608.

8. Wang HI, Yiang GT, Hsu CW, Wang JC, Lee CH, Chen YL. 2017; thyroid storm in a patient with trauma - a challenging diagnosis for the emergency physician: case report and literature review. J Emerg Med. 52(3):292–8. DOI: 10.1016/j.jemermed.2016.09.003. PMID: 27742400.

9. Romijn M, Geeraedts LMG Jr, Verbeke J, Finken MJJ. 2021; An adolescent with transient hyperthyroxinemia after blunt trauma to head and neck. Case Rep Endocrinol. 2021:6628035. DOI: 10.1155/2021/6628035. PMID: 33927905. PMCID: PMC8049829.

10. Hagiwara A, Murata A, Matsuda T, Sakaki S, Shimazaki S. 2007; Thyroid storm after blunt thyroid injury: a case report. J Trauma. 63(3):E85–7. DOI: 10.1097/01.ta.0000232184.07317.56. PMID: 18073590.

11. Heizmann O, Schmid R, Oertli D. 2006; Blunt injury to the thyroid gland: proposed classification and treatment algorithm. J Trauma. 61(4):1012–5. DOI: 10.1097/01.ta.0000238621.83780.e0. PMID: 17033582.