Emergency Thyroidectomy for a Bleeding Multinodular Goitre
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Emergency Thyroidectomy for a Bleeding Multinodular Goitre
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Original source:
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Irfan Mohamad, Shah Jihan Wan Din
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Emergency Thyroidectomy for a Bleeding Multinodular Goitre
Year: 2009
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Goitre, a slow-growing thyroid mass, is rarely an emergency condition; however, complications such as acute intralesional bleeding or infections can lead to rapid size increase. This case report discusses a 70-year-old female patient with a long-standing multinodular goitre who experienced significant bleeding from the left thyroid mass. Despite conservative management, the bleeding persisted until she underwent an emergency thyroidectomy, which effectively resolved the issue.
Intralesional Hemorrhage: An Acute Presentation
The case highlights that intralesional bleeding from a thyroid mass can present acutely, demonstrating the importance of timely surgical intervention. In this patient, the bleeding, which manifested as a slow oozing from the mass surface, was significant enough to cause a drop in hemoglobin levels to 7 g/dL. Conservative measures such as blood transfusions and compression dressings were initially attempted; however, the persistent nature of the bleeding necessitated surgery. Upon histological examination post-thyroidectomy, the findings confirmed nodular goitre with intralesional hemorrhage, underscoring that such complications can arise from benign thyroid conditions as well.
Conclusion
The occurrence of intralesional bleeding in a benign thyroid mass, as illustrated in this case report, emphasizes the need for awareness of potential acute presentations associated with goitres. In emergency situations involving thyroid swelling, timely surgical intervention is crucial to address complications such as bleeding and airway obstruction. This case serves as a reminder that while goitre may not typically present as an emergency, the implications of intralesional bleeding warrant prompt evaluation and appropriate surgical management.
FAQ section (important questions/answers):
What is a goitre and how does it present?
A goitre is a slow-growing thyroid mass. It rarely presents as an emergency unless it is complicated by an infection or acute intralesional bleeding, which can cause rapid swelling and potential symptoms.
What caused the patient's bleeding from the thyroid mass?
The patient experienced bleeding from a long-standing multinodular goitre, with intralesional hemorrhage occurring via thinning of the skin. The mass was associated with a history of rapid growth and bluish discoloration.
How was the patient's bleeding managed before surgery?
Initially, the patient was managed conservatively with packed cell transfusion, intravenous fluid replacement, and compression dressing. However, despite these measures, continuous bleeding persisted, necessitating emergency surgery.
What surgical procedure was performed to address the bleeding?
A complete thyroidectomy was performed to arrest the bleeding. The surgery was successful in stopping the hemorrhage and involved careful dissection to avoid injury to surrounding structures.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Emergency Thyroidectomy for a Bleeding Multinodular Goitre”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Bleeding:
Bleeding refers to the loss of blood, which in this case occurred from a thyroid mass due to intralesional hemorrhage. It is critical in this patient, as it led to a significant drop in hemoglobin level and necessitated emergency intervention via thyroidectomy to control the bleeding and prevent further complications.
2) Swelling:
Swelling describes the enlargement of the thyroid mass observed in the patient, which had been present for over ten years. This swelling raised concerns for potential intralesional bleeding and necessitated medical evaluation, showcasing the goitre's transformation from a chronic issue to an acute surgical emergency when bleeding occurred.
3) Dressing:
Dressing pertains to the application of a compressive bandage to control the bleeding from the thyroid mass. Despite initial conservative management, frequent changing of the dressing every few hours indicated continuous blood loss, underscoring the limited effectiveness of conservative treatment and reinforcing the need for surgical intervention.
4) Surface:
Surface refers to the outer area of the thyroid mass from which the bleeding emanated. This aspect is crucial in identifying the nature of the bleeding, as it was superficial. Understanding the surface characteristics aided in the decision-making for the surgical approach to address the bleeding effectively.
5) Blood:
Blood is the vital fluid circulated throughout the body, and its loss through the bleeding thyroid mass significantly impacted the patient's health, leading to anemia with a hemoglobin level of 7 g/dL. This critical situation represented the urgency for surgical intervention to restore blood volume and stabilize the patient.
6) Nature:
Nature refers to the characteristics of the thyroid swelling, which was described as multinodular goitre with intralesional hemorrhage. Understanding the nature of the mass, including its benign characteristics and the presence of increased vascularity, informed the clinical approach for diagnosis and management, including the urgency for surgery.
7) Study (Studying):
Study in this context relates to the comprehensive investigation employed to understand the thyroid mass's nature, including imaging studies and fine needle aspiration. This multifactorial assessment was critical for forming a management plan, ultimately influencing the decision for emergency thyroidectomy due to acute bleeding.
8) Sign:
Sign refers to the observable indications of the patient's condition, such as the bluish discoloration of the skin over the mass, which suggested bleeding under the surface. Signs are essential for clinical evaluation and management decisions, providing crucial information about the severity and implications of the thyroid pathology.
9) Pain (Paiṇ):
Pain signifies a potential symptom experienced by patients with thyroid swellings, particularly if they progress to cause complications like hemorrhage or airway obstruction. While not explicitly mentioned in this case, understanding the pain associated with such conditions is critical for diagnosing, evaluating, and determining the urgency of surgical intervention.