Title: Total Thyroidectomy in a Recurrent Giant Goiter by Isthmus First Technique- A Case Report
Authors: Jitendra T. Sankpal, Mukund B.Tayade, Yogesh S. Torkadi, Shubham D.Gupta, Jasmine R. Agarwal, RuchiraR. Bhattacharya
DOI: https://dx.doi.org/10.18535/jmscr/v4i10.114
A recurrent giant multinodular goiter poses surgical challenges, especially when both lobes extend into retropharyngeal space. So, here we are reporting a technique of operating in such a scenario. The patient presented with a giant goiter extending to lateral part of neck and behind both ears, compressing the trachea and causing stridor with hoarseness of voice and puffiness of face and displacement of carotid to posterior triangle. Fibreoptic bronchoscopy1guided intubation was done due to severe tracheal compression. Total thyroidectomy2 was performed by dividing the isthmus intraoperatively, sparing the parathyroids and Recurrent laryngeal nerves (RLN) at our center, which is a tertiary care teaching hospital. Once thyroid was removed, the outside diameter of trachea was assessed to be normal without any signs of tracheomalacia. Patient tolerated the procedure well and had no postoperative complications. There were no symptoms of RLN injury or any symptoms suggestive of hypoparathyroidism. Her breathing as well as voiceimproved significantly postoperatively. We conclude that total thyroidectomy with the technique of early division of isthmus in a case of giant thyroid swelling is associated with easier access to and dissection of deeper structures with better postoperative results and lesser complications. 1. Collins SR, Blank RS. Fiberoptic intubation: an overview and update. Respir Care. 2014;59(6):865-78-80. doi:10.4187/respcare.03012. 2. Veyseller B, Aksoy F, Demirhan H, et al. [Total thyroidectomy in benign thyroid diseases]. Kulak burun boğaz Ihtis Derg KBB = J ear, nose, throat. 19(6):299-303. http://www.ncbi.nlm.nih.gov/pubmed/20030598. Accessed October 7, 2016. 3. Tezelman S, Borucu I, Senyurek Giles Y, Tunca F, Terzioglu T. The change in surgical practice from subtotal to near-total or total thyroidectomy in the treatment of patients with benign multinodular goiter. World J Surg. 2009;33(3):400-405. doi:10.1007/s00268-008-9808-1. 4. Srivastava D, Dhiraaj S. Airway management of a difficult airway due to prolonged enlarged goiter using loco-sedative technique. Saudi J Anaesth. 2013;7(1):86-89. doi:10.4103/1658-354X.109829. 5. Mizuno J, Nakano M, Kasuya M, Nishiyama T, Hanaoka K. [A case of giant thyroid tumor with tracheal stenosis]. Masui. 2004;53(6):682-686. http://www.n-cbi.nlm.nih.gov/pubmed/15242045. Accessed October 7, 2016. 6. Randolph GW, Kobler JB, Wilkins J. Recurrent laryngeal nerve identification and assessment during thyroid surgery: laryngeal palpation. World J Surg. 2004;28(8):755-760. doi:10.1007/s00268-004-7348-x. 7. Page C, Strunski V. Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goitre: report of 351 surgical cases. J Laryngol Otol. 2007;121(3):237-241. doi:10.1017/S0022215106003501. 8. Pfleiderer AG, Ahmad N, Draper MR, Vrotsou K, Smith WK. The timing of calcium measurements in helping to predict temporary and permanent hypocalcaemia in patients having completion and total thyroidectomies. Ann R Coll Surg Engl. 2009;91(2):140-146. doi:10.1308/003588409X359349. 9. Testini M, Gurrado A, Lissidini G, Nacchiero M. Hypoparathyroidism after total thyroidectomy. Minerva Chir. 2007;62(5):409-415. http://www.ncbi.nl-m.nih.gov/pubmed/17947951. Accessed October 7, 2016.Abstract
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