Emergency thyroidectomy: Due to acute respiratory failure

Zulfu Bayhan; Sezgin Zeren; Bercis Imge Ucar; Isa Ozbay; Yalcin Sonmez; Metin Mestan; Onur Balaban; Nilufer Araz Bayhan; Mehmet Fatih Ekici

doi:10.1016/j.ijscr.2014.11.012

Emergency thyroidectomy: Due to acute respiratory failure

Int J Surg Case Rep. 2014;5(12):1251-3. doi: 10.1016/j.ijscr.2014.11.012. Epub 2014 Nov 11.

Authors

Zulfu Bayhan¹, Sezgin Zeren², Bercis Imge Ucar³, Isa Ozbay⁴, Yalcin Sonmez⁵, Metin Mestan⁶, Onur Balaban⁷, Nilufer Araz Bayhan⁸, Mehmet Fatih Ekici⁹

Affiliations

¹ Department of General Surgery, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey. Electronic address: zulfubayhan@gmail.com.
² Department of General Surgery, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey. Electronic address: sezginzeren@gmail.com.
³ Department of General Surgery, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey. Electronic address: bercis.imge@gmail.com.
⁴ Department of Otolaryngology, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey. Electronic address: isaozbay@gmail.com.
⁵ Department of General Surgery, Dumlupinar University Evliya Celebi Education and Research Hospital, 43020 Kutahya, Turkey. Electronic address: dryalcinsonmez@gmail.com.
⁶ Department of General Surgery, Dumlupinar University Evliya Celebi Education and Research Hospital, 43020 Kutahya, Turkey. Electronic address: metinmestan@gmail.com.
⁷ Department of Anesthesiology and Reanimation, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey. Electronic address: obalabandr@gmail.com.
⁸ Department of Anesthesiology and Reanimation, Dumlupinar University Evliya Celebi Education and Research Hospital, 43020 Kutahya, Turkey. Electronic address: niluferaraz@gmail.com.
⁹ Department of General Surgery, Dumlupinar University Evliya Celebi Education and Research Hospital, 43020 Kutahya, Turkey. Electronic address: mfatihekici@gmail.com.

Abstract

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.

Keywords: Awake intubation; Giant goiter; Laryngotracheal compression; Respiratory failure; Retrosternal; Thyroidectomy.