{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T12:53:19Z","timestamp":1791118399781,"version":"4.1.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019779","name":"Qatar National Library","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019779","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Spontaneous hemorrhage within a thyroid nodule is an uncommon but potentially alarming condition presenting with acute neck pain, swelling, and compressive symptoms that may threaten the airway and pose diagnostic and management challenges. We describe a 35-year-old Asian woman who presented with sudden onset of severe left-sided neck pain and swelling, accompanied by dysphagia and exertional dyspnea. There was no history of trauma, anticoagulant use, or prior thyroid intervention. Physical examination revealed marked unilateral thyroid tenderness and swelling without overt airway compromise. Thyroid function tests were within normal limits. Neck ultrasonography demonstrated a complex mixed solid\u2013cystic left thyroid nodule measuring 3.2\u2009\u00d7\u20092.4\u2009\u00d7\u20093.5\u00a0cm with internal echogenic septations, consistent with a hemorrhagic thyroid cyst. Initial conservative management with non-steroidal anti-inflammatory drugs provided minimal relief. The patient was subsequently treated with a short course of high-dose oral corticosteroids and underwent ultrasound-guided fine-needle aspiration, yielding 7\u00a0mL of dark brown hemorrhagic fluid. Cytological examination revealed macrophage-predominant cyst contents with no evidence of malignancy. Significant symptomatic improvement was noted following aspiration and steroid therapy. The patient was referred for endocrinology follow-up, with elective hemithyroidectomy discussed due to the potential risk of recurrence. Spontaneous hemorrhage of a thyroid nodule, although rare, should be considered in patients presenting with acute unilateral neck pain and swelling, even in the absence of identifiable risk factors. Early imaging, vigilant airway assessment, and individualized management are crucial. In clinically stable patients, conservative treatment with aspiration and corticosteroids may be effective, while surgical intervention should be reserved for recurrent cases or those with airway compromise. This case highlights the critical role of primary care physicians in early recognition and urgent referral of rare but potentially life-threatening thyroid conditions presenting with acute neck swelling.<\/jats:p>","DOI":"10.1093\/omcr\/omag179","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T11:20:32Z","timestamp":1789384832000},"source":"Crossref","is-referenced-by-count":0,"title":["Spontaneous Hemorrhagic thyroid cyst presenting as unilateral painful thyroiditis in primary care: early recognition of a potentially life-threating complication"],"prefix":"10.1093","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6009-3339","authenticated-orcid":false,"given":"Khaled E","family":"Elzawawi","sequence":"first","affiliation":[{"name":"College of Medicine, QU Health, Qatar University ,","place":["P.O. Box 2713, Doha, Qatar"]},{"name":"Family Medicine Residency Program, Department of Medical Education, Hamad Medical Corporation , P.O. Box 3050, Doha ,","place":["Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7227-9042","authenticated-orcid":false,"given":"Ibrahim","family":"Elmakaty","sequence":"additional","affiliation":[{"name":"Family Medicine Residency Program, Department of Medical Education, Hamad Medical Corporation , P.O. Box 3050, Doha ,","place":["Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaydaa","family":"Ali","sequence":"additional","affiliation":[{"name":"Family Medicine Residency Program, Department of Medical Education, Hamad Medical Corporation , P.O. Box 3050, Doha ,","place":["Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mays","family":"Al-Krosh","sequence":"additional","affiliation":[{"name":"Family Medicine Residency Program, Department of Medical Education, Hamad Medical Corporation , P.O. Box 3050, Doha ,","place":["Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleh M H","family":"Attal","sequence":"additional","affiliation":[{"name":"Family Medicine Department, Primary Health Care Corporation , P.O. Box 26555, Doha ,","place":["Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasha","family":"Moussa","sequence":"additional","affiliation":[{"name":"Family Medicine Department, Primary Health Care Corporation , P.O. Box 26555, Doha ,","place":["Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"key":"2026100408213400400_ref1","volume-title":"StatPearls"},{"key":"2026100408213400400_ref2","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/s12902-025-01869-5","article-title":"Prevalence and predictors of thyroid nodules among adults: analyzing the association with metabolic syndrome in a cross-sectional study","volume":"25","author":"Abrishami","year":"2025","journal-title":"BMC Endocr Disord"},{"key":"2026100408213400400_ref3","doi-asserted-by":"publisher","DOI":"10.1093\/jscr\/rjae124","article-title":"Spontaneous hemorrhagic thyroid nodule: a case report and review of the literature","volume":"2024","author":"Alsalamah","year":"2024","journal-title":"J Surg Case Rep"},{"key":"2026100408213400400_ref4","doi-asserted-by":"publisher","first-page":"932","DOI":"10.4081\/cp.2017.932","article-title":"Spontaneous thyroid hemorrhage on chronic anticoagulation therapy","volume":"7","author":"Gunasekaran","year":"2017","journal-title":"Clin Pract"},{"key":"2026100408213400400_ref5","doi-asserted-by":"publisher","first-page":"192","DOI":"10.4158\/EP-2019-0326","article-title":"Spontaneous thyroid nodule hemorrhage in the emergency department","volume":"26","author":"Covino","year":"2020","journal-title":"Endocr Pract"},{"key":"2026100408213400400_ref6","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/1752-1947-9-3","article-title":"Arteriovenous malformation of the thyroid gland as a very rare cause of mechanical neck syndrome: a case report","volume":"9","author":"\u010cern\u00e1","year":"2015","journal-title":"J Med Case Rep"},{"key":"2026100408213400400_ref7","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1177\/0310057X0203000220","article-title":"Haemorrhage of a thyroid cyst as an unusual complication of intubation","volume":"30","author":"Szeto","year":"2002","journal-title":"Anaesth Intensive Care"},{"key":"2026100408213400400_ref8","doi-asserted-by":"publisher","first-page":"468","DOI":"10.4158\/EP.16.3.468","article-title":"American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European thyroid association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations","volume":"16","author":"Gharib","year":"2010","journal-title":"Endocr Pract"},{"key":"2026100408213400400_ref9","doi-asserted-by":"publisher","first-page":"289","DOI":"10.4274\/tao.2021.2021-5-23","article-title":"Management of a spontaneous thyroid nodule hemorrhage causing acute airway obstruction","volume":"59","author":"Ba\u015fak","year":"2021","journal-title":"Turk Arch Otorhinolaryngol"},{"key":"2026100408213400400_ref10","doi-asserted-by":"publisher","DOI":"10.3897\/folmed.67.e139405","article-title":"Spontaneous thyroid cyst hemorrhage \u2013 a case report","volume":"67","author":"Covantsev","year":"2025","journal-title":"Folia Med"},{"key":"2026100408213400400_ref11","doi-asserted-by":"publisher","first-page":"e23846","DOI":"10.1097\/MD.0000000000023846","article-title":"The associated factors for spontaneous intranodular hemorrhage of partially cystic thyroid nodules: a retrospective study of 101 thyroid nodules","volume":"99","author":"Yang","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"2026100408213400400_ref12","doi-asserted-by":"publisher","first-page":"269","DOI":"10.5152\/B-ENT.2025.241626","article-title":"Spontaneous intrathyroidal hemorrhage\u2014a rare potential life-threatening condition","volume":"20","author":"Selleslag","year":"2024","journal-title":"Acta Otorhinolaryngol Belg"},{"key":"2026100408213400400_ref13","first-page":"247","article-title":"Thyroid gland hematoma after blunt neck trauma","volume":"10","author":"Saylam","year":"2009","journal-title":"West J Emerg Med"},{"key":"2026100408213400400_ref14","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1080\/00325481.1983.11698396","article-title":"How to detect hypothyroidism when screening tests are normal. 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