• Liuhong Shi, Caoxin Yan, Wen Xu, and Pintong Huang.
• Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
• Medicine (Baltimore). 2018 Sep 1; 97 (36): e12149.

RationaleIntravenous thrombolysis is the primary therapy for acute ischemic stroke (AIS), but it has some complications, including symptomatic intracranial hemorrhage, orolingual angioedema, and extracranial bleeding. However, thyroid disorders associated with thrombolysis are very rare.Patient ConcernsA 56-year-old man developed acute pain and neck swelling after thrombolysis with recombinant tissue plasminogen activator.DiagnosesUltrasound revealed a diffusely enlarged thyroid with linear hypoechoic areas throughout the entire gland, resembling a "cracked" appearance.InterventionsThe patient was treated conservatively with cold packs and observed closely. Follow-up ultrasound was made.OutcomesA few hours later, pain and swelling disappeared completely. A repeat ultrasound revealed complete recovery of thyroid volume and aspect on the next day.LessonsAfter intravenous thrombolysis for AIS, several life-threatening complications, such as hemorrhage and orolingual angiedema, also can cause neck swelling. Urgent intubation and surgery may be required. However, the rare complication, acute diffuse thyroid swelling, is self-limiting and nonfatal and conservative treatment is sufficient. Neck ultrasound is helpful in rapidly distinguishing these complications.

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