Severe neck pain: a report of 3 cases of spontaneous thyroid nodule hemorrhage.

Spontaneous intranodular thyroid hemorrhage (ITH) is a rare clinical occurrence. Previous case reports describe sudden severe neck swelling, often resulting in life-threatening respiratory distress that may necessitate urgent surgical intervention. Although thought to be rare, the true incidence of ITH is unknown, and ITH should be considered in the differential diagnosis of patients presenting with acute neck symptoms, due to its potential to cause airway compromise. We illustrate a more subtle presentation of ITH in a case series of 3 female patients with acute neck swelling and pain: a 34-year-old with no prior history of thyroid disease, a 40-year-old with a history of hypothyroidism, and a 49-year-old with a preexisting history of thyroid nodules. All 3 patients had ultrasounds demonstrating spontaneous ITH which resolved with conservative management. In noncompressive lesions, conservative management with watchful waiting and surveillance ultrasounds is a reasonable approach.