Endocrine Abstracts

Introduction: Giant multinodular goiter (MNG) is a heterogeneous clinical disorder that can be asymptomatic or can cause compression of surrounding structures, and when it is accompanied by obstructive symptoms such as dyspnea, it carries an indication for surgery. Pulmonary hypertension is one of the most important complications of untreated hyperthyroidism, that can be reversible under treatment.

Case presentation: We present a case of 75 years old female with a giant MNG with a rapid increase in size within 3 years, with atrial fibrillation, palpitations, breathlessness on exertion and dyspnea. She is diagnosed with toxic nodular goiter since 60 years old, not regularly treated. Computed tomography scan of the neck shows a gross enlargement of thyroid. The trans-thoracic cardiac ultrasound shows dilatation of left atrium, right ventricular dilatation, pulmonary hypertension, with no evidence of pulmonary embolism in angio-ct. The fine needle aspiration suggested MNG with adenomatous nodules and toxic changes. She was treated with 20 mg methimazole daily; after 4 weeks the patient’s palpitations improved but still complained shortness of breath. To check the heart status and pulmonary hypertension, following the treatment of thyrotoxicosis, the patient underwent echocardiography, and the pulmonary pressure was significantly reduced. A total thyroidectomy was performed and the gland was dissected successfully.

Conclusion: Pulmonary hypertension, associated hyperthyroidism, is a common complication, usually reversed after treatment of thyroid disease. Surgical management is recommended for goiters with compressive symptom, in aim to improved breathing and swallowing outcomes after thyroidectomy. With careful preoperative testing and thoughtful consideration of the type of anesthesia, including the type of intubation, preparation for surgery can be optimized.