CASE 17871 Published on 31.08.2022

'Shock thyroid'—a rare feature of the CT hypoperfusion complex

Section

Head & neck imaging

Case Type

Clinical Cases

Authors

Filipe Barros Alves1,2, Margarida Morgado1,2, Sílvia Costa Dias1,2, Bruno Araújo1,2, António José Madureira1

1. Centro Hospitalar Universitário de S. João, EPE; Alameda Prof. Hernâni Monteiro 4200-319 Porto, Portugal

2. Faculdade de Medicina da Universidade do Porto; Alameda Prof. Hernâni Monteiro 4200-319 Porto, Portugal

Patient

14 years, female

Categories
Area of Interest Emergency, Head and neck, Thyroid / Parathyroids ; Imaging Technique CT
Clinical History

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.

Imaging Findings

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”.

Discussion

“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. [1]

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. [3]

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.

Differential Diagnosis List
Shock thyroid
Thyroiditis
Multinodular goiter
Thyroid lymphoma
Final Diagnosis
Shock thyroid
Case information
URL: https://www.eurorad.org/case/17871
ISSN: 1563-4086
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