Open AccessMyasthenic Crisis Manifesting as Postoperative Respiratory Failure following Resection of Unsuspected Intrathoracic Thymic T-Cell Lymphoma during Thyroidectomy for an Adjacent Large Retrosternal Goiter
Author(s) -
Mohamed E. Ahmed,
Mohamed Mahgoub,
Mohamed G. Alnedar,
Seif I. Mahadi,
Maha Alzubeir,
Lamyaa Ahmed Mohamed El Hassan,
Elwaleed Mohamed Elamin,
Amro B. Hassan
Publication year - 2014
Publication title -
european thyroid journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.23
H-Index - 10
eISSN - 2235-0802
pISSN - 2235-0640
DOI - 10.1159/000364822
Subject(s) - medicine , goiter , asymptomatic , thyroidectomy , median sternotomy , surgery , respiratory failure , thymoma , respiratory distress , anesthesia , thyroid
A middle-aged female with a goiter of 10 years' duration presented with progressive pressure symptoms, nocturnal choking and dyspnea on exertion for 5 months. Physical examination demonstrated a large simple multinodular goiter. Imaging revealed a deep retrosternal goiter extending below the tracheal bifurcation with marked tracheal deviation. Total thyroidectomy was carried out via a cervical approach and a median sternotomy. Extubation was not possible, and the patient had to be kept intubated. She then went into a myasthenic crisis. Initial ventilatory support was followed by intravenous immunoglobulin, steroids and pyridostigmine. The patient had complete remission and was asymptomatic 18 months later. Histopathology showed a T-cell-rich thymoma in addition to a nodular colloid goiter.