Benign cervical multi-nodular goiter presenting with acute airway obstruction: a case report

INTRODUCTION: Benign cervical goiters rarely cause acute airway obstruction. CASE PRESENTATION: We report the case of a 64-year-old woman of African descent who presented with acute shortness of breath. She required immediate intubation and later a total thyroidectomy for a benign cervical multi-nodular goiter with no retrosternal tracheal compression. CONCLUSION: Benign multi-nodular goiters are commonly left untreated once euthyroid. Peak inspiratory flow rates should be measured via spirometry in all goiters to assess the degree of tracheal compression. Once tracheal compression is identified, an elective total thyroidectomy should be performed to prevent morbidity and mortality from acute airway obstruction.

Secondary thyroid surgery

The rationale of recommending surgery for recurrent goitre was discussed (AU)

The thyroid gland in Jamaica

This thesis describes some aspects of the anatomy and physiology of the thyroid gland in Jamaicans. The purpose of the investigation was to discover if any alteration occurred in thyroid gland activity as a result of the prevailing tropical conditions. Thyroid glands were collected from consecutive post-mortem examinations at the University Hospital of the West Indies. It was shown that the thyroid gland in the average Jamaican weighted somewhat less than is usual elsewhere, but that this reduction could be accounted for by a general reduction in body weight. It was also demonstrated that in this highly selected population, there was a low incidence of goitre and that there was a very low incidence of thyroid nodules. Thyroid function was estimated using a variety of tests involving the use of radioactive iodine. Following a pilot study using the technique of thyroid clearance of radioactive iodine, thyroid function was estimated in a local population the people all being in good health and living in their normal state. The isotopic studies were combined with estimations of stable iodine excretions. It was shown that the daily excretions of stable iodine were on the lower border of normal. This observation is of special interest when the low incidence of goitre is remembered. These results indicated that there is reduced thyroid function in Jamaicans. It is thought that this represents part of the process of acclimatization to a hot environment. The results have been useful also in establishing normal values for a variety of tests of thyroid function which are used in the University Hospital in Jamaica (AU)

Studies on thyroid nodules in Jamaica

Preliminary studies in thyroid weight, incidence of nodules and iodine content at autopsy indicate that in Jamaica, all these parameters are low. Functional studies indicate a low rate of thyroid activity and an apparent border-line iodine deficiency. The low incidence of nodules at autopsy suggests, however, that iodine deficiency is not a major factor in the pathogenesis of goitre in Jamaica. On the other hand, approximately 50 patients are operated on each year at the U.C.H.W.I for non toxic nodular goitre. Studies are therefore being made of the surgically removed thyroid tissue in this group by means of electrophoresis and chromatography of iodinated proteins and amino acids in the hope of uncovering some other pathogenetic factors (AU)