A 71‐year‐old female with giant goiter associated with tracheomalacia

Abstract

Case: A 71-year-old woman was admitted to the Emergency Department with severe dyspnea followed by unconsciousness. She had a history of hyperthyroidism and her anterior neck was markedly swollen. After ventilation was started, she soon became conscious with the improvement of oxygenation. Computed tomography findings indicated giant goiter surrounding the trachea. Later, we carried out a thyroidectomy for the giant goiter (800 g), and tracheostomy. Bronchoscopy carried out at the end of surgery showed a deformed tracheal wall on breathing. During inspiration, the collapsed wall of the trachea occluded the airway, although the tracheal wall recovered to normal during expiration. We diagnosed this case as acquired tracheomalacia and a tracheal stent graft made of silicon was inserted immediately after bronchoscopy.Outcome: After stent graft insertion, the patient was transferred to another hospital. Conclusion: Emergency physicians should be aware of the causes of tracheomalacia in order to safely carry out treatment, particularly in the case of patients with giant goiter.

Clinical Characteristics and Predictors Related to the Progression of Multinodular Goiter Causing Tracheal Compression and Deviation: A Report of Two Cases and Review of the Literature

“…Graves' disease is a common cause of hyperthyroidism, due to diffuse swelling and enhanced blood flow to the thyroid gland, involving TRAb ( 32 ); notably, the production of TRAb can stimulate the enlargement of the thyroid volume. In our literature review, no etiology was stated for 9 of the 12 patients with hyperthyroidism, and 3 were diagnosed with toxic MNG ( 10 - 12 , 18 , 22 , 28 ). Ten of the 12 patients were reported from Europe.…”

“…TFT results were reported for 42 patients. Notably, 13 of the 42 patients showed hyperthyroidism (10,11,12,18,22,27), despite the TFT data not being severe. Thyroglobulin levels were not present in the reviewed literature.…”

“…1). Twenty publications (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) including 42 patients were reviewed based on the evaluation method summarized in Fig. 1.…”

“…The total median transverse length of the bilateral thyroid lobes in 5 patients (1 evaluated by histopathology and 4 evaluated by CT) ( 9 , 17 , 26 ) was 82 (62-98) mm. The median thyroid volume was 275 (range, 156-800) mL in 8 patients (6 evaluated by histopathology and 2 evaluated by CT) ( 10 , 22 ). A case series involving 65 asymptomatic patients with upper way obstruction reported by Sorensen et al ( 28 ) revealed a median thyroid volume of 58 (14-642) mL, as determined by magnetic resonance imaging.…”