Dyspnea after thyroidectomy induced by intratracheal lymphoma: A case report

Wu, Chaojie; Da, Dongzhu; Wang, Jing; Qiao, Gaoang; Zheng, Mingming; Xu, Ming; Jiang, Yongxin; Liu, Jun

doi:10.3892/mco.2019.1896

Cited by 1 publication

(2 citation statements)

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“…It was performed by the endocrine surgeon, thus initially avoiding post TT airway obstruction and early postoperative respiratory distress. In cases without tracheostomy, this respiratory distress is characteristically seen usually shortly after extubation, which makes this complication predictable, detectable and preventable ( 8 , 9 ). After the initial postoperative improvement, the patient returned in a few days to the ED, because of reappearance of neck stiffness, dyspnea, voice tiredness, subfebrile condition and difficult swallowing.…”

Section: Discussionmentioning

confidence: 99%

“…The immediate patient's management consists of reintubation with or without tracheostomy, followed by definitive treatment (4,5). In comparison, delayed airway obstruction, presenting even days after TT is due to unexpected events, like tracheal compression because of postoperative neck oedema, inflammation or hemorrhage (6)(7)(8)(9). These delayed postoperative pitfalls, though infrequent, are possible and unexpected, which represent a critical emergency (10,11).…”

Section: Introductionmentioning

confidence: 99%

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Delayed respiratory distress after thyroidectomy—another challenge for us: a case report

Belitova¹,

Popov²,

Marinov³

2023

Gland Surg

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Background: Delayed airway obstruction and the resulting severe dyspnea with acute distress are rare but life-threatening postoperative thyroidectomy complications. Unfortunately, if not adequately attended to on time, they could cost a patient's life.Case Description: A 47-year-old female patient who underwent thyroidectomy was left at the end of surgery with a tracheostomy, because of tracheomalacia and recurrent laryngeal nerve injury. Within the next ten days, her health condition gradually worsened. She complained of unexpected symptoms of shortness of breath, airway compromize and neck inflammation even with the existing tracheostomy tube. In face of new onset dyspnea, without giving proper attention to the postoperative course of this complicated patient, the consulting otorhinolaryngologist decided to decannulate the patient on the sixth postoperative day. This precipitated the presentation of an extensive neck infection with resultant total bilateral vocal fold immobility, followed by life-threatening airway obstruction, due to an unintentionally forgotten gauze in peritracheal space during thyroidectomy. In critical condition, the patient was successfully intubated with Rapid Sequence Induction, which enabled ventilation, oxygenation and saved the patient's life. After definitively securing the airway, she underwent tracheostomy with tracheal re-cannulation. After a prolonged antimicrobial course and achieving voice rehabilitation, the patient was decannulated.Conclusions: Post thyroidectomy dyspnea is possible even with tracheostomy in place. The decisionmaking in the management of a thyroidectomy patient is of paramount importance not only intraoperatively, but also in the postoperative period and the gland surgeon expertise is of supreme value for avoiding lifethreatening complications. In case of postoperative complaints, the patient should be referred first to the gland surgeon and only thereafter to other medical consultants. Disregarding a variety of factors like patient characteristics, risk factors and comorbidity, available diagnostic tools and specific recovery profile could cost the patient's life.

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Section: Discussionmentioning

confidence: 99%