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Misaki M, Kawakita N, Hara T, Yamagami H, Takeuchi T, Miyamoto N, Sakamoto S, Inoue S, Goto M, Toba H, Takizawa H. Silicone stent placement for tracheal stenosis induced by a giant goiter due to Graves' disease: a case report. Gland Surg 2024; 13:578-583. [PMID: 38720672 PMCID: PMC11074657 DOI: 10.21037/gs-23-499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/29/2024] [Indexed: 05/12/2024]
Abstract
Background Although thyroid tumors with tracheal stenosis are occasionally encountered, severe tracheal stenosis caused by benign thyroid tumors is rare. We herein describe a case in which a silicone tracheal stent was placed for severe tracheal stenosis induced by a giant goiter due to Graves' disease. Case Description A 93-year-old woman had been receiving thiamazole treatment for Graves' disease with a thyroid goiter for 32 years. She emergently presented to the hospital with sudden difficulty breathing and the temporary loss of consciousness. Although marked stridor was heard, the patient's respiratory status was stable in the first visit. Computed tomography revealed a giant thyroid goiter that extended to the mediastinum. The trachea was compressed by the sternal notch and thyroid gland, resulting in severe stenosis, and the tracheal lumen was only 1 mm. Surgical thyroidectomy was expected to be difficult due to the high risk of complications associated with the large size of the goiter and advanced age of the patient. Therefore, we decided to place a tracheal stent. A silicone stent (Dumon tube®) was inserted into the site of tracheal stenosis under general anesthesia. After stent placement, respiratory distress symptoms improved, and no complications were observed. Three months after stent placement, the stent opening side was narrowed due to defective granulation and, thus, was cauterized with argon plasma coagulation. Conclusions We encountered a patient who was treated by tracheal silicone stent placement for severe tracheal stenosis induced by a giant goiter due to Graves' disease. A silicone stent effectively secures the airway for benign thyroid tumors that cause severe airway stenosis.
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Affiliation(s)
- Mariko Misaki
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health, Biosciences, The University of Tokushima, Tokushima, Japan
- Department of Esophagus, Breast and Thyroid Surgery, Tokushima University Hospital, Tokushima, Japan
| | - Naoya Kawakita
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health, Biosciences, The University of Tokushima, Tokushima, Japan
- Department of Esophagus, Breast and Thyroid Surgery, Tokushima University Hospital, Tokushima, Japan
| | - Tomoyo Hara
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hiroki Yamagami
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Taihei Takeuchi
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health, Biosciences, The University of Tokushima, Tokushima, Japan
- Department of Esophagus, Breast and Thyroid Surgery, Tokushima University Hospital, Tokushima, Japan
| | - Naoki Miyamoto
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health, Biosciences, The University of Tokushima, Tokushima, Japan
- Department of Esophagus, Breast and Thyroid Surgery, Tokushima University Hospital, Tokushima, Japan
| | - Shinichi Sakamoto
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health, Biosciences, The University of Tokushima, Tokushima, Japan
- Department of Esophagus, Breast and Thyroid Surgery, Tokushima University Hospital, Tokushima, Japan
| | - Seiya Inoue
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health, Biosciences, The University of Tokushima, Tokushima, Japan
- Department of Esophagus, Breast and Thyroid Surgery, Tokushima University Hospital, Tokushima, Japan
| | - Masakazu Goto
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health, Biosciences, The University of Tokushima, Tokushima, Japan
- Department of Esophagus, Breast and Thyroid Surgery, Tokushima University Hospital, Tokushima, Japan
| | - Hiroaki Toba
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health, Biosciences, The University of Tokushima, Tokushima, Japan
- Department of Esophagus, Breast and Thyroid Surgery, Tokushima University Hospital, Tokushima, Japan
| | - Hiromitsu Takizawa
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health, Biosciences, The University of Tokushima, Tokushima, Japan
- Department of Esophagus, Breast and Thyroid Surgery, Tokushima University Hospital, Tokushima, Japan
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Piosamy NM, Gunasekaran A, Jha AK, Govindaraj K. Perioperative Challenges in Combined Total Thyroidectomy and Aortic Valve Replacement. Ann Card Anaesth 2024; 27:175-176. [PMID: 38607884 PMCID: PMC11095778 DOI: 10.4103/aca.aca_135_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/26/2023] [Accepted: 10/11/2023] [Indexed: 04/14/2024] Open
Affiliation(s)
- Noel M. Piosamy
- Department of Anaesthesia and Critical Care, JIPMER, Puducherry, India
| | | | - Ajay K. Jha
- Department of Anaesthesia and Critical Care, JIPMER, Puducherry, India
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Zhu Q, Zhou H, Ren G, Wang Y, Sui Y. A new treatment strategy for airway obstruction induced by a giant benign goiter: A case report. Exp Ther Med 2023; 26:376. [PMID: 37456157 PMCID: PMC10347117 DOI: 10.3892/etm.2023.12075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023] Open
Abstract
Severe respiratory distress induced by airway obstruction requires prompt attention for restoration of normal function in the airway passage. A large benign thyroid goiter that compresses the trachea is a rare occurrence. Emergency thyroidectomy with dyspnea can increase the chance of surgical complications in such cases. Here, a rare case of dyspnea induced by a large goiter is reported and a safe and effective therapeutic strategy for treatment was demonstrated. First, a self-expandable metal stent was placed to relieve airway obstruction. A week later, total thyroidectomy under general anesthesia was performed. After 3 months, the metal stent was surgically removed. The findings of the present case report demonstrated that life-threatening airway obstruction secondary to benign goiter could be effectively treated by placing an airway stent, followed by thyroidectomy.
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Affiliation(s)
- Qinwei Zhu
- Department of Emergency, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong 261041, P.R. China
| | - Hongyuan Zhou
- Department of Emergency, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong 261041, P.R. China
| | - Guifang Ren
- Department of Hospital Office, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Yonghui Wang
- Department of Thyroid and Breast Surgery, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Yana Sui
- Department of Emergency, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong 261041, P.R. China
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Sharma N, Govil V, Vashishth S, Rashmi, Saini AK, Kad N. A Rare Presentation of Thyroid Mass- A case report. Indian J Otolaryngol Head Neck Surg 2023; 75:984-987. [PMID: 37274953 PMCID: PMC10234890 DOI: 10.1007/s12070-022-03179-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/23/2022] [Indexed: 11/09/2022] Open
Abstract
Background-Respiratory symptoms are not uncommon in thyroid diseases and can be overlooked and misdiagnosed as acute exacerbation of asthma or COPD. Case report- A 58 years old female presented to emergency department with complaints of fever, shortness of breath from last 3-4 days for which she intubated in emergency department and shifted to ICU. Next day patient was absolutely fine and extubated and was planned to be shifted out surprisingly the same episode was repeated following which patient was intubated again and was found to be absolutely normal after 3-4 h and extubated again. The same episode was repeated next day as well. Eventually she was diagnosed to have cystic thyroid swelling. Immediate aspiration of the cyst done to relieve the symptoms and total thyroidectomy was done subsequently and patient was cured of the symptoms. Conclusion- Acute airway obstruction can occur in asymptomatic goitre patients. The anaesthetic management is crucial for airway till definitive surgery is done. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03179-x.
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Affiliation(s)
- Namarta Sharma
- Department of Anaesthesia, Pt BD Sharma PGIMS, Rohtak, India
| | - Vasudha Govil
- Department of Anaesthesia, Pt BD Sharma PGIMS, Rohtak, India
| | | | - Rashmi
- Department of Anaesthesia, Pt BD Sharma PGIMS, Rohtak, India
| | - Aman Kaur Saini
- Department of Anaesthesia, Pt BD Sharma PGIMS, Rohtak, India
| | - Nandita Kad
- Department of Anaesthesia, Pt BD Sharma PGIMS, Rohtak, India
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Niu JM, Zhang J, Qiu XJ, Wang J, Pei YH, Wang YL, Wang T. Application of Micro-Tech stents in malignant carinal stenosis. Oncol Lett 2019; 17:3990-3996. [PMID: 30930995 DOI: 10.3892/ol.2019.10051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 02/01/2019] [Indexed: 11/06/2022] Open
Abstract
Malignant carinal stenosis is a disease process that is not always suitable for treatment with a Y-shaped stent. When one of the main bronchi is completely obstructed and cannot be recanalized, or its distal lung tissue has lost function, inserting a Y-shaped stent is infeasible. In this complex condition, a cone-shaped stent is selected to maintain the patency of the trachea and the other main bronchus. The efficacy of the bare cone-shaped Micro-Tech stent to treat malignant carinal stenosis was evaluated in the current study. The medical records of 47 patients with malignant carinal stenosis who underwent Micro-Tech stent placement between January 2004 and October 2017 in Beijing Tian Tan Hospital (Beijing, China) were analyzed retrospectively. A total of 47 bare Micro-Tech stents (28 Y-shaped and 19 cone-shaped) were successfully inserted in the patients. Following stent placement, immediate satisfactory results were achieved in all patients, especially an improvement of dyspnea (100%), cough (81.1%) and stridor (100%). The Karnofsky scores were significantly increased (P<0.001), and the American Thoracic Society Dyspnea Index values were significantly decreased (P<0.001). Following a median of 88 days, initial bronchoscopic interventions were performed for tumor overgrowth (84.6%), stent fracture (7.7%) and granulation tissue (7.7%). Restenting was performed in two patients due to tumor progression (n=1) and stent fracture (n=1). Removal of a Y-shaped stent was attempted in one patient, but failed, as the stent had become partly embedded in the airway mucosa. In conclusion, cone-shaped Micro-Tech stent placement maintained tracheal-unilateral main bronchus patency and benefitted patients with malignant carinal stenosis in whom Y-shaped stents were not suitable for insertion.
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Affiliation(s)
- Jin-Mu Niu
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Jie Zhang
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Xiao-Jian Qiu
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Juan Wang
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Ying-Hua Pei
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Yu-Ling Wang
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Ting Wang
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
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