Acute thyroid swelling after fine needle aspiration biopsy.

To the Editors, A 67­year­old woman presented with a solitary nodule in the left lobe of the thyroid gland. She was clinically and chemically euthyroid. Thyroid function test showed serum free thyroxine 1.01 ng/dl (normal 0.83–1.44 ng/dl), free triiodothyronine 1.91 pg/ml (normal 1.73­3.20 pg/m) and thyrotropin 1.25 mIU/L (normal 0.49­4.67 mIU/L). An ultrasound examination of thyroid gland showed an isoreflective nodule with cystic degeneration (figure 1). The size of the nodule and the right and the left lobes were 4.1x2.8x2.5 cm, 3.8x2.3x1.3 cm and 4.5x3.3x2.7 cm, respectively (thyroid volume 26.9 ml). Fine­needle aspiration (FNA) of the nodule was performed using a 22­gauge needle and a 20­ml disposable syringe without previous local anesthesia. There were no complications during or immediately after the procedure. Within an hour the entire thyroid gland including the unmanipulated right lobe unexpectedly enlarged to more than twice normal size (thyroid volume 62.3 ml, the right lobe 4.5x2.9x3.0 cm and the left lobe 4.8x3.7x4.5 cm). No ecchymosis or local swelling was found at the needle­insertion site. Additional ultrasonography revealed an inhomogeneous parenchyma in the enlarged thyroid gland (figure 1). There was no sign suggesting intrathyroidal bleeding or airway obstruction. Hydrocortisone (200 mg) was administered intravenously and the patient was kept in observation. The swelling disappeared 20 hours later. The right lobe measured 2.3x1.8 cm and the nodule was 2.4x2.2 cm in size. IJCRI 2011 ;2(11 ):28-29. www.ijcasereportsandimages.com