Endocrine Abstracts

This is an unusual case of sleep apnoea treated with C-PAP as a result of multinodular goitre (MNG) which was overlooked.

This is a case of a 69-year-old gentleman who was referred to the endocrine clinic for assessment of his diabetes. Sleep apnoea was diagnosed around four years ago and he has been using C-PAP every night. Enlargement of multinodular goitre coincided with the diagnosis of sleep apnoea. He has previously been seen by another endocrinologist and in view of pressure symptoms was referred to a surgeon for thyroidectomy. The operation was declined by the surgeon and anaesthetist as he was considered to be high risk due to his diabetes mellitus, body habitus (trunkal obesity) and sleep apnoea. He had learnt to live with his condition and uses C-PAP every night despite neck discomfort.

On examination, he had a very large multinodular goitre no dysphonia, dysphagia, except for a feeling of discomfort in his neck especially when he uses C-PAP at night time.

After lengthy discussion he agreed to be further assessed for total thyroidectomy which was performed a few weeks later. A few months after surgery he no longer required C-PAP. He was discharged from the sleep apnoea clinic and was told his condition is cured.

Conclusion: One should take a holistic approach and detailed assessment of multinodular goitre, especially in patients with sleep apnoea who are considered high risk for surgery. MNG could well be a main contributory factor and thyroidectomy could be a cure!