Endocrine Abstracts

A 40-year-old gentleman was referred with sudden onset discomfort in the neck associated with the development of a lump. Earlier that morning he had carried out breathing exercise known as surya krishna at 0600 h and noticed the lump 3 h later whilst shaving. Thyroid USS showed a right-sided thyroid cyst, aspiration of which yielded haemorrhagic contents. FNA of the solid component of the wall did not reveal any malignant cells. The fluid re-accumulated with pressure symptoms including a gritty discomfort when talking, pain and heaviness in this region. Repeat scan did not reveal any significant changes in the appearance of the thyroid cyst. Surya krishna is a breathing exercise lasting 30–60 min with times of hyperventilation and other times of slow breathing. He recalled experiencing pins and needles, numbness and tingling with the hyperventilation but felt energetic at the end of the session. However, at the beginning of the session there is an emphasis placed on breathing through the throat and he remembered exerting a certain pressure in the throat region when doing this. We hypothesise that the pressures involved during the breathing exercises may have been sufficient to cause haemorrhaging within a thyroid nodule. The authors have seen two other cases presenting in a similar manner.