A case of fatal tracheal compression in a patient with Hashimoto's disease under the setting of previous tracheostomy

This autopsy case involved a woman in her 60 s with a history of temporal tracheostomy. During an event in which her son allegedly experienced an epileptic seizure, he grasped the woman around the upper chest for several moments. The woman then experienced breathing difficulties, lost consciousness and died. Postmortem computed tomography revealed a pinhole-like tracheal narrowing at the level of the tracheostomy encircled by the thyroid. Autopsy revealed a modestly enlarged thyroid gland due to previously undiagnosed Hashimoto's disease and an old fracture in a tracheal ring indicating that the trachea had been compressed by the thyroid. Hashimoto's disease rarely causes sudden death through systemic endocrine disturbance, but this case may illustrate that against a background of previous tracheostomy that mechanically weakens the trachea, enlargement of the thyroid (goiter) as a local effect of the disease can also cause sudden death.