Bayhan Z, Zeren S, Ucar BI, Ozbay I, Sonmez Y, Mestan M, Balaban O, Bayhan NA, Ekici MF. Emergency thyroidectomy: Due to acute respiratory failure.
Int J Surg Case Rep 2014;
5:1251-3. [PMID:
25437688 PMCID:
PMC4276272 DOI:
10.1016/j.ijscr.2014.11.012]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 11/22/2022] Open
Abstract
CT scan has a great value for retrosternally extended giant goiter cases.
If the general status of the patient prevents CT scan, bedside ultrasound can be used instead.
Nasal awake intubiation is an appropriate choice for the patients with destructed trachea.
Emergency thyroidectomy is a common option for the treatment of giant goiter causing airway obstruction.
INTRODUCTION
Giant cervical and mediastinal goiter may lead to acute respiratory failure caused by laryngotracheal compression and airway obstruction. Here, we present a case admitted to the emergency service with a giant goiter along with respiratory failure and poor general health status, which required urgent surgical intervention.
PRESENTATION OF CASE
A 71-year-old female admitted to the emergency room with shortness of breath and poor general health status resulting from a giant cervical swelling progressively increased during the last 7 years and constituted severe respiratory failure which has become severe in the last one month. A giant nodular goiter of the left thyroid lobe extending retrosternally, causing tracheal compression, limiting the neck movements was detected with clinical examination and bedside ultrasound. Emergency thyroidectomy was planned. Fiberoptic-assisted awake nasal intubation was performed in the operating room. Emergency total thyroidectomy was performed for the life-threatening respiratory failure. Postoperative period was uneventful. She was transferred from intensive care unit to the ward on postoperative day 3 and was discharged from the hospital on the postoperative 7th day. Benign multinodular hyperplasia was reported on the histopathological report. Patient was included in routine follow-up.
DISCUSSION
In the present case tracheal destruction due to compression of the giant goiter was found in agreement with previous reports. Emergency thyroidectomy was performed after awake intubation since it is a common surgical option for the treatment of giant goiter causing severe airway obstruction.
CONCLUSION
Respiratory failure due to giant nodular goiter is a life-threatening situation and should be treated immediately by performing awake endotracheal intubation following emergency total thyroidectomy.
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