Emergency thyroidectomy: Due to acute respiratory failure

Bayhan, Zülfü; Zeren, Sezgin; Uçar, Bercis İmge; Özbay, İsa; Sönmez, Yalçın; Mestan, Metin; Balaban, Onur; Bayhan, Nilüfer Araz; Ekici, Mehmet Fati̇h

doi:10.1016/j.ijscr.2014.11.012

Cited by 6 publications

(5 citation statements)

References 6 publications

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“…In the assessment of respiratory distress, stridor is a key sign that directs the physician to the upper airway. It is noteworthy that, in similarity to our case, other published cases in which goitre caused T2RF also do not mention stridor in the clinical presentation 4–6. This suggests a potentially dangerous pattern in which airflow limitation to critical levels causing hypercapnia may result in inaudible airway noises analogous to the scenario in which a non-wheezing silent chest can be mistaken for improved airflow in a hypercapnic asthmatic patient.…”

Section: Discussionsupporting

confidence: 80%

“…The incidence of such presentations is not well documented although studies estimate this to be around 0.6–1.3% with a notable predilection for female patients although this may reflect increased baseline incidence of goitre in women 2 3. Presentation of goitre with decompensated type two respiratory failure (T2RF) is even rarer with only a few cases reported in the literature including reports by Bakkar et al and Bayhan et al 4 5…”

Section: Introductionmentioning

confidence: 99%

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Benign multinodular goitre presenting as acute decompensated type two respiratory failure

Khalil,

Liyanage,

Ishaq

et al. 2024

BMJ Case Rep

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Acute airway obstruction is a life-threatening complication of benign goitre mostly occurring in cases of known progressing goitres. The index presentation of goitre with decompensated type two respiratory failure is an exceedingly rare and a diagnostically challenging presentation. We discuss the case of a woman in her 50 s, who had been diagnosed with asthma by her general practitioner, but during admission was found to have a large goitre with retrosternal extension causing critical tracheal compression. She presented with acute decompensated type two respiratory failure. We explore the diagnostic confounding posed by the patient’s background of asthma and describe the initial management of the patient with non-invasive ventilation by the emergency department. The diagnosis of upper airway obstruction was not apparent which is an interesting anomaly in this case. She underwent an emergency hemithyroidectomy and recovered with a resolution of her respiratory symptoms. Histology confirmed benign multinodular hyperplasia.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Benign multinodular goitre presenting as acute decompensated type two respiratory failure

Khalil,

Liyanage,

Ishaq

et al. 2024

BMJ Case Rep

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“…CT and MRI are preferred by many physicians and surgeons for evaluation of thyroid gland volume when US is considered insufficient due to different sizes or properties of the thyroid gland. Although it is neither cost- nor time-effective compared to US, the CT scan has great value in the preoperative evaluation of the patient and satisfactorily shows the thyroid size, substernal and mediastinal extension of the thyroid gland and its invasion into surrounding tissues and organs [4,24]. Previous studies have shown that, except for cases with substernal goiter, TV measured by US did not differ significantly from that measured by CT [25,26].…”

Section: Discussionmentioning

confidence: 99%

“…Respiratory distress caused by tracheal compression from the thyroid gland is an accepted indication for a thyroidectomy procedure [1,2,3,4]. Increased thyroid volume (TV) may cause respiratory symptoms due to continuous irritation of the upper airway [5], and with time, tracheal narrowing may lead to stridor and persistent hypoxia [6].…”

Section: Introductionmentioning

confidence: 99%

Determining the Thyroid Gland Volume Causing Tracheal Compression: A Semiautomated 3D CT Volumetry Study

et al. 2019

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Background and objectives: Increased thyroid gland volume (TV) may bring about tracheal compression, which is one of the causes of respiratory distress. The aim of this study was to investigate the relationship between TV and the severity of tracheal compression independent of patients’ symptoms using semiautomated three-dimensional (3D) volumetry (S3DV) reconstructed from computed tomography (CT) scans. Cut-off TVs leading to different levels of tracheal narrowing were evaluated. Materials and Methods: One hundred sixty-three contrast-enhanced head and neck CT examinations were retrospectively assessed. TVs were measured by S3DV. The degree of tracheal compression was measured at the point where the greatest percent reduction in the cross-sectional area of the trachea adjacent to the thyroid gland was observed. To determine the severity of compression, the tracheal compression ratio (TCR) was defined (TCR = A1 (the narrowest cross-sectional area of trachea)/A2 (the largest cross-sectional area of trachea)). Results: The mean tracheal narrowing was 15% (TCR = 0.85 ± 0.15) in the study population. Patients with more than 15% tracheal compression had significantly higher TV values than those with less than 15% tracheal compression (p < 0.001). In addition, a significant correlation was found between TV and tracheal compression (p < 0.001). Moreover, the receiver operating characteristic (ROC) curve analysis revealed that the cut-off levels for TV that predict a tracheal narrowing of 10%, 20%, 30%, and 40% were 19.75 mL, 21.56 mL, 24.54 mL, and 30.29 mL, respectively (p < 0.05). Conclusions: This study objectively demonstrated that larger thyroid glands cause more severe compression on the trachea. The results may be helpful during the decision-making process for thyroidectomies to be performed due to compression symptoms.

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“…1,3 Initial treatment used to be medical, and surgery is reserved for refractory cases, with urgent thyroidectomy only in cases of acute airway obstruction and recommended to be performed by an endocrine surgeon that can handle giant goiter complications, with nerve monitoring systems to minimize these damages. 3 The progression through the giant goiter should be considered and treated as soon as possible. The timing surgical intervention allow us to avoid morbidity and mortality associated, and for this reason it would be desirable to complete attention during the first stages of disease.…”

Section: Discussionmentioning

confidence: 99%

Cardiogenic Shock Secondary to Thyroid Goiter Case Report

Andrade¹

2016

MOJCR

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Background: Thyroid goiter can appear in some developing countries, related with iodo deficiencies. The main complications associated with goiter is airway obstruction, but cardiogenic shocks have not been reported previously. Case:We report the case of a 59year-old woman who comes to general surgery consultation for an anterior cervical mass associated with weakness, fatigue, and relative incapacity to complete her activities. At physical exam a thyroid goiter was suspected and ultrasound confirms this. Symptomatology was attributed to thyroid function disturbance and hormonal levels of TSH, T3 and T4 were confirmed as normal. Preoperative evaluation by Internal Medicine service was requested. One week later patient come to this evaluation with increased symptomatology, pallor, bradycardia, tachypnea, and parents refers a syncope too. At physical exam she was diaphoretic, with Glasgow of 12 points, pallor, cardiac frequency of 40 beats per minute and arterial pressure of 80/40mmHg, yugular ingurgitation, dyspnea, tachypnea of 27 breaths per minute, diminished peripheral pulses and distal cyanosis. CT scan refers a compressive mass dependent of left thyroid hemisphere without occlusion of airway and we appreciate a compression of left carotid artery. Patient does not improve with medical management and a cardiogenic shock secondary to carotid sinus stimulation was suspected, reason why an emergency thyroidectomy was scheduled. Hemi-thyroidectomy was completed without complications and after 24hours' patient was recovered and asymptomatic, confirming our suspects. Conclusion:This case is a very rare presentation of multinodular thyroid goiter, without previous similar reports, but with high relevance to consider it in a similar scenario because the delate in urgent surgical management could worsen outcomes.

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Emergency thyroidectomy: Due to acute respiratory failure

Cited by 6 publications

References 6 publications

Benign multinodular goitre presenting as acute decompensated type two respiratory failure

Benign multinodular goitre presenting as acute decompensated type two respiratory failure

Determining the Thyroid Gland Volume Causing Tracheal Compression: A Semiautomated 3D CT Volumetry Study

Cardiogenic Shock Secondary to Thyroid Goiter Case Report

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