A giant toxic multinodular goiter extending into the retropharyngeal space: A case report

INTRODUCTION

In areas with iodine deficiency, multinodular goiter is a prevalent cause of hyperthyroidism. If left untreated, it can grow until it is noticeably huge in size. Although it is a rare clinical phenomenon, thyroid swelling extending into the retro-pharyngeal space presents a substantial difficulty for the surgeon. In this article, we report a giant thyroid mass that had extended to the retro-pharyngeal space and how it posed a challenge during surgery.

CASE PRESENTATION

Female, 30-year-old, presented with a huge goiter of 15 years duration which extended to retro-visceral space and completely encircled them without extension to retro-sternal space. After the patient was rendered euthyroid with propylthiouracil (PTU), the thyroid mass was removed surgically. Postoperatively, the patient developed only a transient, asymptomatic hypocalcemia, as a complication.

DISCUSSION

If a goiter is large enough, it can grow inferiorly into the mediastinum and outside the typical boundaries of the thyroid bed. However, they rarely grow into the retro-pharyngeal space and present a management issue. The management of this patient was also more complicated as the goiter grew enormous and giant, particularly when it came to controlling the airway and surgically removing the tumor.

CONCLUSION

A preoperative CT scan is an important part of diagnostic studies for a giant goiter to diagnose extrathyroidal bed extension. Total or near-total thyroidectomy through a large cervical incision is the mainstay of treatment for such patients to relieve compression symptoms and treat associated hyperthyroidism.

The Role of Ultrasound-Guided Fine-Needle Aspiration of Thyroid Bed Lesions and Clinical Predictors of Recurrent Papillary Thyroid Carcinoma

OBJECTIVES

Fine-needle aspiration (FNA) of thyroid bed lesions after thyroidectomy is challenging to evaluate. We determined the sensitivity, specificity, and positive and negative predicative value of thyroid bed FNA (TB-FNA) for detecting local recurrence of thyroid carcinoma.

METHODS

A retrospective search was conducted for TB-FNAs from patients with a prior thyroid resection and subsequent ipsilateral FNA from the thyroid bed. Clinical and pathologic data were retrieved from the medical record. Patients were ultimately classified as "malignant" or "benign" based on the worst pathology identified and follow-up available.

RESULTS

Forty-two cases were included, and the prior thyroidectomy pathology included 36 papillary thyroid carcinomas, two follicular carcinomas, one medullary carcinoma, and three benign cases. TB-FNA was adequate in 38 (90.5%) cases and interpreted as positive for malignancy (n = 22; 52.4%), suspicious for follicular neoplasm (n = 3; 7.1%), atypia of unknown significance (n = 2; 4.8%), and benign (n = 10; 23.8%). Twenty-seven patients had histologic follow-up, and 24 (87.5%) showed recurrent malignancy. The cytology sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 96%, 100%, 100%, 92.3%, and 97.4%, respectively, for identification of recurrent malignancy.

CONCLUSIONS

Most TB-FNA cases ultimately were diagnosed with malignancy on follow-up, although there may be sampling bias, as not all clinically benign cases had surgical follow-up.

The usefulness of fine-needle aspirates for detection of recurrent carcinoma in the thyroid bed

INTRODUCTION

Locoregional recurrence of thyroid carcinoma has a negative impact on patient prognosis. In the current study, we retrospectively reviewed cases of thyroid bed lesions in the last 3 years, correlating cytologic diagnoses with clinical findings and, whenever available, final surgical diagnosis.

MATERIALS AND METHODS

Cytologic results and needle wash thyroglobulin results from patients with fine-needle aspiration (FNA) of thyroid bed lesions were retrospectively collected from our electronic files. Additional retrieved data included sex, age at diagnosis, previous thyroidectomy diagnosis, time lapse since surgery, and corresponding surgical diagnosis (whenever available).

RESULTS

A total of 91 cases from 72 patients (54 F, 18 M) were retrieved from the electronic files, with a median age of 49 years. Average interval between surgery and thyroid bed FNA was 5 years. Thyroglobulin levels were available for 60 (65.2%) cases. The average level was 276.2 ug/mL, with a range of <0.1 to 4720 ug/mL. Information on final surgical diagnosis was available for 31 samples. Complete agreement between final cytologic and histologic diagnoses was achieved in 28 of 31 (90.3%) of the cases, with 1 false negative and 2 false positives. Cytology sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.2%, 71.4%, 90.9%, 83.3%, and 89.1%, respectively.

CONCLUSIONS

Ultrasound-guided FNA is an accurate and minimally invasive diagnostic method for suspicious thyroid bed lesions, with high sensitivity and positive predictive value.