title: Management of airway compromise following thyroid cyst hemorrhage after thrombolytic therapy.
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.
authors.affiliation: Department of Otolaryngology, New York University, New York, New York, U.S.A.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Gallant
authors.forename: Mark A
authors.initials: MA
authors.lastname: Fritz
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Paul
authors.forename: Peter D
authors.initials: PD
authors.lastname: Costantino
mesh_terms: D000402:Airway Obstruction / Q000139:chemically induced / Q000601:surgery*; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D005500:Follow-Up Studies; D006044:Goiter, Nodular / Q000150:complications* / Q000601:surgery; D006406:Hematoma / Q000150:complications* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013965:Thyroidectomy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use; D014140:Tracheotomy / Q000379:methods
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: airway; goiter; hemorrhage; tPA; thyroid