Endocrine Abstracts

Tracheomalasia is extremely rare condition in Graves’ disease and may result in pneumomediastium with fistular formation from longstanding compression by a large goiter. There is no report that Graves’ disease combined with tracheomalasia and pneumomediastinum. A 24-year-old woman presented with abdominal pain, diarrhea and fever. On physical examination, a large goiter was detected on her anterior neck. Computed tomography of chest showed large amount of air in anterior mediastinum. Twelve years ago, she was diagnosed Graves’ disease and had not taken antithyroid drug regularly. The laboratory findings were markedly decreased TSH compared to increased thyroid hormone level and positive auto-antibody for thyroid (TBII, TSH binding inhibitory immunoglobulin). Thyroid storm was diagnosed and appropriate management was performed by using antithyroid drug, lugol solution, dexamethasone and propranolol. Dyspnea was developed because of aspiration pneumonia, mechanical ventilation was needed. After being normal range of free T₄, total thyroidectomy was performed. four soft and floppy tracheal rings with fistular formation were found on operation field. Extubation of endotracheal tube was difficult due to tracheomalasia, so tracheostomy was done. Weight of thyroid gland was 119.5 g. Airway obstruction is also possible due to flaccid tracheal ring after removing hard goiter encasing trachea.Therefore, in cases of total thyroidectomy with large longstanding goiter, extreme caution should be used.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.