台耳醫誌

Thyroid nodules affect around 5% of adults, with a higher prevalence in regions with iodine deficiency and among older women. While most thyroid nodules, approximately 95%, are benign, fine-needle aspiration is still necessary for assessing potential malignancy. Although complications from thyroid fine-needle aspiration are uncommon, extremely rare yet catastrophic events like massive hematomas with airway compromise can occur.
A 49-year-old woman presented with acute neck swelling, dysphagia, and dyspnea 30 minutes after thyroid fine-needle aspiration. Her medical history included hypertension, ulcerative colitis, and thyroid goiters. Despite initially stable vital signs, she developed respiratory failure within an hour, necessitating intubation. CT imaging revealed a large retropharyngeal hematoma with active bleeding, which resulted in tracheal deviation, as confirmed by contrast extravasation. CT angiography identified the source of bleeding to the left superior thyroid artery. Transcatheter arterial embolization was successfully performed within 5 hours, and the patient was subsequently transferred to the ICU. As the hematoma had not adequately resolved, the patient underwent a left total thyroidectomy to address the issue. The patient had a favorable recovery and was discharged.
Fine-needle aspiration is the preferred, cost-effective, and safe technique for thyroid nodule evaluation. Fatal complications are rare but may occur, emphasizing the importance of preventive measures during the procedure and prompt intervention for massive hematoma. (J Taiwan Otolaryngol Head Neck Surg 2025; 59:125-131)