Management of airway compromise following thyroid cyst hemorrhage after thrombolytic therapy

Laryngoscope. 2015 Mar;125(3):604-7. doi: 10.1002/lary.24841. Epub 2014 Jul 14.

Abstract

The risk of hemorrhage after therapeutic administration of tissue plasminogen activator (tPA) is well known. Cases of postadministration hemorrhage have been reported within many organ systems. We present a case of a 62-year-old female with undiagnosed thyroid goiter who received tPA for acute ischemic stroke and developed acute airway compromise. The surgical airway response team was called due to inability to ventilate or intubate. An incision into the mass during attempted tracheotomy released colloid and blood, decompressing the airway and facilitating ventilation and intubation. Hemithyroidectomy for mass removal was delayed for 3 days to allow normalization of post-tPA coagulopathy.

Keywords: airway; goiter; hemorrhage; tPA; thyroid.

Publication types

  • Case Reports

MeSH terms

  • Airway Obstruction / chemically induced
  • Airway Obstruction / surgery*
  • Brain Ischemia / complications
  • Brain Ischemia / drug therapy*
  • Female
  • Fibrinolytic Agents / adverse effects
  • Fibrinolytic Agents / therapeutic use
  • Follow-Up Studies
  • Goiter, Nodular / complications*
  • Goiter, Nodular / surgery
  • Hematoma / complications*
  • Hematoma / surgery
  • Humans
  • Middle Aged
  • Thrombolytic Therapy / adverse effects*
  • Thyroidectomy / methods*
  • Tissue Plasminogen Activator / adverse effects*
  • Tissue Plasminogen Activator / therapeutic use
  • Tracheotomy / methods

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator