RESUMEN
Goiter is a localized or generalized thyroid hypertrophy. It can remain within the cervical region or grow down until it invades the mediastinum. The signs and symptoms depend on the size and location of the goiter. Although drugs and radioactive iodine are often used to treat thyroid disease, the presence of symptomatic substernal goiter is a clear indication for surgery. Death or postoperative complications rarely occur. We present a case of a 71-year-old man with recurrent thyroid pathology in the form of substernal goiter and hyperthyroidism even after partial thyroidectomy. The importance of this relates to the clinical evolution, volume, and location of the goiter as well as the surgical and pharmacological approach.
Asunto(s)
Bocio Subesternal/patología , Bocio Subesternal/cirugía , Tiroidectomía/métodos , Anciano , Bocio Subesternal/diagnóstico por imagen , Humanos , Masculino , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
SUMMARY Goiter is a localized or generalized thyroid hypertrophy. It can remain within the cervical region or grow down until it invades the mediastinum. The signs and symptoms depend on the size and location of the goiter. Although drugs and radioactive iodine are often used to treat thyroid disease, the presence of symptomatic substernal goiter is a clear indication for surgery. Death or postoperative complications rarely occur. We present a case of a 71-year-old man with recurrent thyroid pathology in the form of substernal goiter and hyperthyroidism even after partial thyroidectomy. The importance of this relates to the clinical evolution, volume, and location of the goiter as well as the surgical and pharmacological approach.
RESUMO O bócio é a hipertrofia da glândula tiroide localizada ou generalizada. Esta pode localizar-se na região cervical ou crescer através do mediastino. Os sinais e sintomas dependem do tamanho e da localização do bócio. Embora os fármacos e o iodo radioativo sejam frequentemente usados para tratar doenças tireoidianas, a presença do bócio subesternal sintomático é uma clara indicação para a cirurgia. A morte ou complicações pós-operatórias são raras. Apresentamos o caso de um homem de 71 anos com recorrência de patologia tireoidiana sob a forma de bócio subesternal e hipertireoidismo após tireoidectomia parcial. A importância desse caso relaciona-se com a evolução clínica, o volume e a localização do bócio e a abordagem cirúrgica e farmacológica desse tipo de patologia.
Asunto(s)
Humanos , Masculino , Anciano , Tiroidectomía/métodos , Bocio Subesternal/cirugía , Bocio Subesternal/patología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Bocio Subesternal/diagnóstico por imagenRESUMEN
Objectives: To describe characteristics and immediate results of surgical treatment of patients with intrathoracic goiter (ITG). Methods: Retrospective review. Period: October 2003 - March 2010. We describe general characteristics, morbidity and mortality. Results: 33 patients, 23 women, mean age 59.1 +/- 14.3 years. Preoperative thyroid function: 32 euthyroid and 1 hyperthyroid. Asymptomatic 10 patients. ITG rate: 31 cervico-mediastinal and 2 mediastinal. Approach: 24 cervicotomy, 7 cervicotomy and sternotomy and 2 sternotomy. Type of resection: 19 total thyroidectomy and 14 subtotal thyroidectomy. Histology: 29 benign and 4 malignant neoplasms. Postoperative stay: median of 4.5 days. Complications in 12 patients: 10 hypo-parathyroidism (9 transient and 1 permanent), 2 dysphonia, 2 cervical hematoma (one redo), 1 wound infection and 1 ventilator associated pneumonia. One patient died (pneumonia). Conclusions: The ITG is more common in women, most are euthyroid and may be asymptomatic. Most can be resected by cervicotomy. The histology is benign in most but may represent malignancies. The surgery is not free of morbidity and mortality.
Objetivos: Describir características y resultados inmediatos del tratamiento quirúrgico de pacientes con Bocio Intratorácico (BIT). Material y Método: Revisión retrospectiva. Período: octubre de 2003 - marzo de 2010. Se describen características generales y morbi-mortalidad. Resultados: 33 pacientes, 23 mujeres, edad promedio 59,1 +/- 14,3 años. Comorbilidades: 12 hipertensos y 1 diabético. Función tiroidea preoperatoria: 32 eutiroideos y 1 hipertiroideo. Asintomáticos 10 pacientes. Tipo BIT: 31 cérvico-mediastínicos y 2 mediastínicos. Abordaje: 24 cervicotomía, 7 cervicotomía más esternotomía y 2 esternotomía. Tipo de resección: 19 tiroidectomía total y 14 tiroidectomía subtotal. Histología: 29 benignos y 4 neoplasias malignas. Estadía postoperatoria: mediana de 4,5 días. Complicaciones en 12 pacientes: 10 hipoparatiroidismos (9 transitorios y 1 permanente), 2 disfonías, 2 hematomas cervicales (uno se reexploró), 1 infección herida operatoria y 1 neumonía asociada a ventilación mecánica. Fallece un paciente (neumonía). Conclusiones: El BIT es más frecuente en mujeres, la mayoría son eutiroideos y pueden ser asintomáticos. La mayoría pueden ser resecados por cervicotomía. La histología es benigna en la mayoría aunque pueden corresponder a neoplasias malignas. La cirugía no está exenta de morbi-mortalidad.