Head & neck imagingCase Type
Filipe Barros Alves1,2, Margarida Morgado1,2, Sílvia Costa Dias1,2, Bruno Araújo1,2, António José Madureira1Patient
14 years, female
A 14-year-old female was admitted to our institution’s Emergency Department after being hit by a bus.
She presented with several visually-apparent injuries, including a large extensively-bleeding open wound of the left lower limb, and without evident neck injury; physical examination revealed a severe hypovolemia state. Serial thyroid function tests were not performed.
Broad radiological evaluation was requested, including full-body CT.
Full-body CT revealed an enlarged heterogeneous hyperenhancing thyroid gland surrounded by fluid (Fig. 1), a collapsed inferior vena cava (Fig. 2), “shock bowel” (Fig. 3) and hyperenhancing adrenal glands (Fig. 4), among other findings.
In the context of the patient’s profound hypovolemic state and considering the other CT findings of CT hypoperfusion complex, the CT features of the thyroid gland suggest “shock thyroid”.
“Shock thyroid” is a rare, probably under-recognized feature of the CT hypoperfusion complex, which occurs in the setting of profound hypovolemic states.
It is hypothesized that “shock thyroid” results from a combination of hypoperfusion of the thyroid gland causing intracellular oedema and death and transient thyrotoxicosis in response to hypovolemia. 
Key CT findings include enlargement, heterogeneity and hyperenhancement (after contrast agent administration) of the thyroid gland and surrounding fluid in the absence of evidence for direct thyroid gland injury. [1,2]
It is unknown whether “shock thyroid” carries any clinical implications. 
Radiologists should be familiar with the appearance of “shock thyroid”, recognizing it as a feature of the “CT hypoperfusion complex” in order to disregard its misleading differential diagnosis when evaluating hypovolemic patients.
Written informed patient consent for publication has been obtained.
 Brochert, A, Rafoth, JB (2006) Shock thyroid: A new manifestation of the hypovolemic shock complex in trauma patients. Journal of computer assisted tomography 30:310-312 (PMID: 16628054)
 Han, DH, Ha, EJ, Sun, JS, Jung, SL (2017) Remarkable CT features of shock thyroid in traumatic and non-traumatic patients. Emergency radiology 24:319-324 (PMID: 16628054)
 Kim, WH, Kim, MS, Kim, JH, Lee, KH, Lee, JH (2021) Shock Thyroid in a Patient with Septic Shock: A Case Report and Literature Review. Journal of the Korean Society of Radiology 82:1328-1333 (PMID: Not available)
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