Acute respiratory failure caused by neglected giant substernal nontoxic goiter

Ioannidis, Orestis; Dalampini, Eleftheria; Chatzopoulos, Stavros; Kotronis, Anastasios; Paraskevas, George; Konstantara, Athina; Papadimitriou, Nikolaos; Makrantonakis, Apostolos; Kakoutis, Emmanouil

doi:10.1590/s0004-27302011000300009

Cited by 13 publications

(23 citation statements)

References 8 publications

(30 reference statements)

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“…No malignancy was observed in histopathological examination of the ectopic thyroid tissue. Differential diagnosis of substernal goiter should be considered for thymomas, lymphomas, pleuropericardial cysts, neurogenic tumors, dermoid cysts, and metastatic lymph node deposits of well-differentiated thyroid carcinoma (1,11).…”

Section: Discussionmentioning

confidence: 99%

Missed retrosternal ectopic thyroid tissue in a patient operated for multinodular goiter

Kesici

Koral

Kesi̇ci̇

et al. 2016

UCD

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Missed retrosternal ectopic thyroid tissue in a patient operated for multinodular goiter INTRODUCTIONEctopic thyroid tissue is a common abnormality due to the abnormal embryological development and migration of thyroid tissue. Ectopic thyroid tissue is commonly seen in the midline of the neck throughout the descending pathway of the thyroid gland (1). Ectopic thyroid tissue can be found from the tongue to the diaphragm. Ectopic thyroid tissue is usually seen in the tongue, submandibular region, cervical lymph nodes, larynx, trachea, oesophagus, mediastinum, diaphragm and heart respectively (2, 3). Although the most common type of ectopic thyroid tissue is lingual, the most common non-cervical location is the thoracic cavity (1). "Forgotten goiter" is an extremely rare situation which is described as a mediastinal thyroid mass found after total thyroidectomy (4).In this article, a case report of a patient with retrosternal ectopic thyroid tissue detected after total thyroidectomy, is presented. CASE PRESENTATIONWe obtained consent from the patient for publication of this case report. In this case report, we discussed a 49 year-old female patient whose retrosternal ectopic thyroid tissue was detected by thyroid scintigraphy taken in postoperative period after total thyroidectomy performed with diagnosis of multinodular goiter. Approximately 3-4 years of swelling and pinching sensation was present on the neck in the anamnesis of the patient who was followed due to multinodular goiter. Palpable nodules were present in both thyroid lobes in physical examination of the patient. Palpable lymph nodes were not present in the neck in physical examination. The right lobe of the thyroid gland was 6 x 2 x 2 cm, the left lobe was 7 x 2.5 x 2 cm and the thickness of isthmus was 1 cm in the neck ultrasonography (USG) of the patient. There were no pathological lymph nodes. Multiple nodules, the largest being over 4 cm on the right (hypoechoic, irregular edged with peripheral halo), were detected in both thyroid lobes in the neck USG of the patient. It was decided to perform total thyroidectomy to the patient. Preoperative blood examinations, chest X-ray and thyroid function tests of the patient were normal. Total thyroidectomy was performed to the patient under general anesthesia. Nineteen milimeters diameter thyroid papillary carcinoma was detected in histopathological examination (capsule invasion and lenfovascular invasion were negative, without extrathyroidal spread).

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Section: Discussionmentioning

confidence: 99%

Missed retrosternal ectopic thyroid tissue in a patient operated for multinodular goiter

Kesici

Koral

Kesi̇ci̇

et al. 2016

UCD

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“…Literatürde retrosternal guatr tanımı hakkında fikir birlikteliği sağlanamamış ve farklı cerrahlar tarafından yapılan 10 değişik tanımlama kullanılmaktadır [3,7]. Lindskog ve Goldenberg tiroid dokusunun 4. torakal vertebra seviyesine uzanmasını retrosternal guatr olarak adlandırırken; Crile ve ark.…”

Section: Discussionunclassified

“…Retrosternal guatr ise ilk olarak Haller tarafından 1749 yılında tanımlanmıştır [2]. Günümüzde retrosternal guatr için 10 farklı tanımlama kullanılmaktadır [3]. Ancak yaygın kabul gören tanımlama Katlic ve ark.…”

Section: Introductionunclassified

Retrosternal Goiter: Analysis of 42 Cases

Yazicioğlu¹

2013

Ann Clin Anal Med

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cases, 16 (38.1%) were male and 26 (61.9%) were female; mean age was 56.4 years (range 31 -79). 10 patients (23.8%) were asymptomatic and the most frequent complaint was dyspnea (n = 18, 42.9%). A collar-incision was used in 22 patients (52.4%), collar + sternotomy to 5 patients (11.9%), and right thoracotomy to 8 patients (19.0%). The most frequently observed thyroid pathology was nodular hyperplasia (n = 32, 76.2%) and 5 patients (11.9%) were diagnosed with thyroid carcinoma. The average duration of hospital stay was 5.6 days (2 -16) and hypoparathyroidic hypocalcemia was determined in 2 patients (4.8%); no mortality was observed. Discussion: Collar incision is adequate for excision in most cases of retrosternal goiter.Sternotomy or thoracotomy can be safely applied with low morbidity rate to cases with suspected adjacency to mediastinal structures.

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“…La clínica inicial suele ser la dificultad respiratoria, tos, sibilancias y estridor, llegando en ocasiones a provocar compromiso vital 4 . La disfagia, disfonía, síndrome de vena cava superior, síndro-me de Horner, accidente isquémico transitorio, edema cerebral o disfunción cardíaca 1 , son otros síntomas que pueden aparecer dependiendo del tamaño y localización del bocio. La espirometría, proporciona información del flujo aéreo permitiendo cuantificar el grado de obstrucción, se sabe que dicha técnica puede mostrar alteraciones en la curva-volumen aún cuando el paciente está asintomático 5,6 .…”

Section: Bibliografíaunclassified

“…Cuando el bocio presenta crecimiento subesternal intratorácico, existe riesgo de compresión de las estructuras adyacentes, tráquea, esófago o vena cava superior 1 . La compresión traqueal se produce frecuentemente (45-50%) 1,2 , pero raramente provoca parada respiratoria. A continuación se presenta un caso clínico en el cual una parada respiratoria es la forma de presentación de un bocio multinodular.…”

Section: Introductionunclassified

Parada respiratoria secundaria a bocio multinodular

Prego¹,

Catalina²,

González³

et al. 2016

Gal. Clin. Vol 77. Num 1

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nar aguda. En la tomografía computarizada (TC) cervical (Figura 1) se observó un importante aumento de tamaño de la glándula tiroides de aspecto multinodular (compatible con bocio multinodular vs neoplasia tiroidea). Se decidió intervención quirúrgica, se le practicó una tiroidectomía total (Figura 2) y traqueotomía. En la anatomía patológica de la pieza quirúrgica se objetivó un bocio multinodular coloide, con signos focales de hiperplasia, amplias áreas de fibrosis y densa hialinización, signos de hemorragia, reciente y antigua, con focos de calcificación. Estos hallazgos confirmaron que el sangrado intratiroideo propició el crecimiento de la glándula y como consecuencia la compresión traqueal. La paciente presentó un postoperatorio no complicado, con buena evolución posterior. DiscusiónEl crecimiento de la glándula tiroidea puede ser de un solo lóbulo o de ambos, simétrico o asimétrico. Cuando el agrandamiento es bilateral, y sobre todo si se extiende a la región posterior del mediastino, puede causar compresión de las estructuras adyacentes, esófago, vena cava superior y tráquea, pudiendo causar en esta última estrechamiento concéntrico. La obstrucción aguda de la vía respiratoria superior puede ser producida por patología tiroidea maligna y benigna, siendo más frecuente en esta última. El caso presentado trata de una compresión traqueal por un bocio multinodular. Las causas por las que un bocio con patología benigna puede causar compresión traqueal son la infección glandular, la hemorragia de las lesiones quísticas tiroideas (como sucede en nuestra paciente) y la patología inflamatoria como la tiroiditis de Hashimoto, la tiroiditis de Quervain o la enfermedad de Graves-Basedow 2,3 . La incidencia de obstrucción traqueal al flujo aéreo IntroducciónEl agrandamiento de la glándula tiroides (bocio), puede producir clínica muy variable dependiendo del tamaño y la localización, pudiendo ser en algunas ocasiones potencialmente grave. Cuando el bocio presenta crecimiento subesternal intratorácico, existe riesgo de compresión de las estructuras adyacentes, tráquea, esófago o vena cava superior 1 . La compresión traqueal se produce frecuentemente (45-50%) 1,2 , pero raramente provoca parada respiratoria. A continuación se presenta un caso clínico en el cual una parada respiratoria es la forma de presentación de un bocio multinodular. Caso ClínicoPaciente mujer de 77 años que es trasladada a Urgencias por episodio de estridor laríngeo con gran dificultad respiratoria. Los servicios de emergencias, comentan que a su llegada al domicilio la encuentran con bradicardia extrema y respiración agónica, que precisó intubación orotraqueal con dificultad de paso subglótica. Tras la intubación, recuperó la saturación oxígeno y se normalizaron las constantes hemodinámicas. Llegó a nuestro centro estable, bajo los efectos de la sedación e ingresó en la Unidad de Cuidados Intensivos. La paciente presentaba como antecedentes personales hipertensión arterial, diabetes mellitus y dislipemia. La familia refería 24-48 horas de evolución...

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Acute respiratory failure caused by neglected giant substernal nontoxic goiter

Cited by 13 publications

References 8 publications

Missed retrosternal ectopic thyroid tissue in a patient operated for multinodular goiter

Missed retrosternal ectopic thyroid tissue in a patient operated for multinodular goiter

Retrosternal Goiter: Analysis of 42 Cases

Parada respiratoria secundaria a bocio multinodular

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