Abstract / Summary
Abstract Background Spontaneous hemorrhage within a thyroid nodule is an uncommon but important benign condition that may present as rapid neck swelling and mimic malignant disease. This diagnostic overlap can lead to unnecessary surgical intervention if not accurately identified. Case Presentation: We report the case of a 30-year-old woman who presented with a two-week history of rapidly enlarging, painless anterior neck swelling. Physical examination revealed a firm, non-tender mass measuring approximately 6 × 6 cm in the left thyroid lobe. Thyroid function tests were normal. Ultrasonography demonstrated a 6.5 × 6 cm complex thyroid nodule with mixed echogenicity and internal fluid–fluid levels, suggestive of intranodular hemorrhage. Fine-needle aspiration (FNA) of the solid component revealed benign follicular epithelial cells with abundant colloid, consistent with a colloid goiter. Aspiration of the cystic component yielded approximately 40 mL of hemorrhagic fluid, with cytology showing red blood cells, hemosiderin-laden macrophages, and cholesterol crystals, without evidence of malignancy. Following aspiration, the swelling showed marked regression with significant symptomatic improvement. The patient was managed conservatively without surgical intervention and remained stable on short-term follow-up. Conclusion Spontaneous intranodular hemorrhage should be considered in the differential diagnosis of rapidly enlarging thyroid masses. FNA plays a crucial role in establishing a definitive diagnosis, preventing misinterpretation as malignancy, and avoiding unnecessary surgery. Early recognition is particularly important in resource-limited settings to optimize patient care and reduce healthcare burden.