Total thyroidectomy for hyperthyroidism is usually curative. We report the unusual recurrence of thyrotoxicosis following a neartotal thyroidectomy. The patient, a 27-year-old woman, elected to have a total thyroidectomy and began levothyroxine after the procedure. Approximately 2 years later, recurrent thyrotoxicosis was evident off levothyroxine. Vascularized thyroid tissue was noted on ultrasound, and a radioactive iodine scan indicated increased uptake in the right thyroid region. She began antithyroid medication and was subsequently treated with radioactive iodine once a euthyroid state was achieved. We discuss the implications of this rare scenario-recurrence of thyrotoxicosis after near-total thyroidectomy.
tient's normally conducted rhythm. The QRS change between native and wide morphologies can be explained based on the variable AV conduction in atrial fibrillation. When the AV conduction in atrial fibrillation is slower, resulting in longer RR interval, the QRS was narrower, as compared with rapid conduction leading to shorter RR interval and wider QRS because of flecainide-associated toxic effects. More importantly, the width of the wider QRS beats with shorter RR intervals progressively improved in this patient and transitioned to baseline-conducted QRS morphology over a period of a day with therapy. This suggests the arrhythmia was atrial fibrillation with conduction rather than dual tachycardia with atrial fibrillation and irregular ventricular tachycardia with similar QRS axis and progressively changing QRS widths.
Background: Complex lower extremity injuries can cause large soft tissue defects that require reconstruction. In the distal third of the lower leg, the reverse sural artery fasciocutaneous flap is a viable coverage option due to its versatility, vascular supply, and ability to cover larger defects than other local pedicled flaps. Although advances in techniques have improved reliability of reverse sural flaps, complications such as donor site morbidity remain a challenge for surgeons. Donor wounds may be difficult to close, and delayed closure can increase the risk for infection and other postoperative complications. In these cases, donor site skin grafting can cause additional morbidity and/or mobility restrictions. Methods: In this case series, 16 patients underwent reconstruction with large reverse sural artery fasciocutaneous flaps and a continuous external tissue expander to assist in donor site closure. Results: One patient was lost to follow-up. All donor sites healed without complication with an average time to healing of 9.2 weeks (n = 15, range: 3–18). At the most recent follow-up, all flaps survived without complication. Conclusions: Given our success in 100% of patients, we purport that this system of enhanced closure may be a valuable adjunctive therapy in closing reverse sural artery fasciocutaneous flaps. We believe that this method may be useful in closing other difficult donor wounds.
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