Acute respiratory failure in a rapidly enlarging benign cervical goitre

Abstract

Benign goitres have the potential to reach massive sizes if neglected, but most have a protracted course that may or may not present with compressive symptoms. We report the case of a 57-year-old man who presented with a rapidly enlarging nodular goitre resulting in acute respiratory failure. Endotracheal intubation and emergency total thyroidectomy were performed, revealing massive thyroid nodules with minimal intrathoracic extension and tracheal erosion. Despite a course and clinical findings suggestive of malignant disease, histopathology was consistent with a benign multinodular goitre. Several cases of benign goitres necessitating endotracheal intubation have been reported. Airway compromise was attributed to a significant intrathoracic component, or inciting events such as thyroid haemorrhage, pregnancy, radioiodine uptake or major surgery. Obstructive symptoms may not correlate well with objective measures of upper airway obstruction such as radiographs or flow volume loops.

Emergency medicine research in the Philippines: A scoping review

“…For case reports, rare adult medicine cases 25 , 26 , 27 , 28 and the proper management of patients with possible drug‐ or disease‐disease interactions 29 , 30 , 31 were the main topics. Each of these case reports, although managed in the ED or the ICU, was produced by physicians outside the field of emergency medicine.…”

“…Primary authors were subspecialty physicians, most commonly from internal medicine. 26 , 27 , 30 , 31 Expertise of the subspecialties endocrinology, 25 cardiology, 26 neurosciences, 29 , 31 psychiatry, 28 , 30 and infectious diseases, 27 were featured; one case report was coauthored by a thoracic and cardiovascular surgeon. 26 The lack of published case reports by emergency physicians is an important observation.…”

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

“…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 median diameter of the main thyroid nodule in 10 patients (4 evaluated by histopathology and 6 evaluated by CT) ( 8 , 15 , 16 , 20 , 21 , 24 , 25 ) was 91 (50-150) mm. The minimum thyroid nodule diameter was 50 mm in our patients with tracheal compression and deviation.…”

Death due to external compression of the trachea in a patient with multinodular hemorrhagic goiter

“…Goiter is the most common thyroid disease in the world; in Italy, with a prevalence of approximately 6 million individuals, it is above the 5% threshold set by the OMS to identify endemic countries [1]. Although goiter is currently only abstractly reported as a possible cause of death in industrialized countries, unavoidable thyroidectomy for severe compression symptoms is not entirely rare [2], although it is more common in developing countries [3].…”