南予医学雑誌　第17巻

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Miyauchi et al.：Acute thyroid swelling with ARDS after FNA南予医誌　Vol.17　No. １　2016－41－IntroductionFine-needle aspiration （FNA） of the thyroid gland is a widely performed procedure for the evaluation of thyroid nodules１） because of its functionality， cost-effectiveness， and low risk for complications. Acute thyroid swelling （ATS） after FNA is a rare complication. ATS that occurs with no major hemorrhaging requires observa-tion or minor treatments such as cold packs and/or nonsteroidal anti-inflammatory drugs２－５）， after which the ATS disappears in a short time with no sequelae. In this report， we describe a patient who developed ATS together with adult respira-tory distress syndrome （ARDS） after un-dergoing FNA. Glucocorticoid therapy was effective in ameliorating both conditions.Case ReportA 64-year-old woman underwent FNA of the thyroid gland at an unafliated clinic in June 2009， to investigate a right thyroid nodule. The patient experienced a tingling sensation in the neck and dyspnea 2 hours after the FNA procedure concluded， and she was transferred to the emergency room of the prefectural hospital. Because the thyroid gland was remarkably enlarged， asphyxia developed rapidly during consultation. Emergency endotracheal intubation with a 5.5 Fr tube was performed， and the patient was referred immediately to our hospital. Cervical computed tomography （CT） im-ages showed remarkable diffuse swelling of the thyroid gland with severe tracheal stenosis （Figure 1）. A chest radiograph showed bilateral diffuse inltration shadows （Figure 2）. Additionally， chest CT images showed bilateral diffuse hyperpermeability pulmonary edemas （Figure 3）. Arterial blood gas tension testing showed that the partial pressure of oxygen was 100 mmHg and the fraction of inspired oxygen was 0.6. The patient was diagnosed with ATS associ-ated with ARDS and was treated with 250 mg of methylprednisolone drip for 2 days. The size of the thyroid gland decreased to its pre-FNA dimensions （Figure 4）. As respiratory function rapidly improved， the patient was extubated; she was discharged 3 weeks afterwards. Approximately 1 year later， total thyroidectomy was performed， and histology conrmed a diagnosis of ade-nomatous goiter of the thyroid. Immunohis-tological staining for calcitonin gene-related peptide （CGRP） was negative.DiscussionThe present case highlights two important clinical issues: First， that FNA can cause ATS with ARDS， and second， that glucocor-ticoid therapy is effective for treating ATS with ARDS. Several studies suggest that the release of vasodilation-inducing substances and allergic reactions are possible causes for acute and transient thyroid swelling. Norren-berg et al. reported that acute swelling and absence of bleeding suggest that vasodilation and diffuse vascular leakage may be the un-derlying mechanism if the symptoms cannot be attributed to allergic reactions６）. Van den Bruel et al. hypothesized that the release