RESUMO
An enlarging thyroid normally extends into the mediastinum, resulting in a presternal or substernal goiter, depending on its migration anteriorly or posteriorly, respectively. The first one was a rare entity in medical literature, being previously reported in only 6 cases worldwide. The present case reports a 54-year woman with a presternal goiter. She had a history of partial thyroidectomy due to a colloid goiter in 2004. Her thyroid function revealed subclinical hypothyroidism. No other abnormalities were present in physical exam or in laboratory tests. A resection of the remaining thyroid tissue was made, with great postsurgical recovery. The anatomopathological study revealed a colloid goiter. Such case porpoise is to remember physicians that unusual presentations of ordinary diseases can occur. This report differs on literature, which demonstrated that papillary thyroid carcinoma is the most important cause of presternal goiter. Moreover, unlike previous reports with normal thyroid function, this case is the only one reported with subclinical hypothyroidism.
Assuntos
Bócio/cirurgia , Glândula Tireoide/diagnóstico por imagem , Tireoidectomia/métodos , Transtornos de Deglutição/etiologia , Dispneia/etiologia , Feminino , Humanos , Hipotireoidismo/complicações , Pessoa de Meia-Idade , Tireotropina/sangue , Tiroxina/sangue , Tomografia Computadorizada por Raios X , Resultado do Tratamento , UltrassonografiaRESUMO
Neste estudo avaliamos o tempo de jejum pré-operatório de pacientes submetidos a cirurgias eletivas no Hospital Universitário Wallace Tadeu de Melo e Silva de Ponta Grossa PR. Cento e vinte pacientes consecutivos submetidos a cirurgias eletivas foram analisados quanto aos tempos de jejum orientado e efetivo. Dados foram coletados durante o período de 2 meses. Não houve critérios de exclusão. Aprovado pelo Comitê de Ética local. Estudo transversal. Os pacientes assinaram o Termo de Consentimento Livre e Esclarecido. Foram realizadas entrevistas diárias em pós-operatório. Análises estatísticas foram realizadas pelo MedCalc (Versão 18). Diferenças consideradas significativas para p < 0.05. Foram encontradas diferenças significativas entre os tempos (horas) de jejum pré-operatórios orientado e efetivo [8 (8 8,5) x 14 (12 17,75); p = 0,0001]; entre os tempos de jejum orientados pelos diferentes profissionais - médicos, enfermeiros, assistentes sociais e nutricionistas [9,5 (8 12) x 8 (8 11) x 8 (8 8) x 8 (8 11); p = 0,006] e entre os tempos de jejum em diferentes turnos de realização dos procedimentos manhã, tarde e noite [12,5h (11,5 13,5) x 17,33h (16 19,2) x 21,75h (20,75 23,5)], p = 0,000001], respectivamente. O tempo de jejum pré-operatório efetivo é superior ao tempo de jejum pré-operatório orientado. O tempo de jejum pré-operatório orientado encontra-se acima do preconizado pela literatura médica atual
- In this study, we evaluated the preoperative fasting time of patients submitted to elective surgeries at the Wallace Tadeu de Melo e Silva University Hospital in Ponta Grossa - PR. One hundred and twenty consecutive patients undergoing elective surgeries were analyzed for times of oriented and effective fasting. Data were collected during the 2-month period. There were no exclusion criteria. Approved by the local Ethics Committee. Cross-sectional study. The patients signed the Informed Consent Term. Daily postoperative interviews were performed. Statistical analyzes were performed by MedCalc (Version 18). Differences considered significant for p <0.05. Significant differences were found between oriented and effective preoperative fasting times [8 (8 - 8,5) x 14 (12 - 17,75); p = 0.0001]; between the fasting times guided by the different professionals - doctors, nurses, social workers and nutritionists - [9.5 (8-12) x8 (8-11) x8 (8-8) x8 (8-11); p = 0.006] and between fasting times in different shifts of the procedures - morning, afternoon and night - [12.5h (11.5-13.5) x 17.33h (16 - 19.2) x 21.75h (20.75 - 23.5), p = 0.000001], respectively. Effective preoperative fasting time is superior to preoperative guided fasting time. Guided preoperative fasting time is above that prevailing in the current medical literature