Open AccessHuge Obstructive Multinodular Goitre in a Pregnant Lady With Pre -Eclampsia: A Therapeutic Dilemma
Author(s) -
Nikma Fadlati Umar,
Norhafiza Mat Lazim,
Sanjeevan Nadarajah,
Wan Rosilawati Wan Rosli,
Irfan Mohamad
Publication year - 2021
Publication title -
international journal of human and health sciences
Language(s) - English
Resource type - Journals
ISSN - 2523-692X
DOI - 10.31344/ijhhs.v5i4.366
Subject(s) - medicine , multinodular goitre , caesarean section , airway obstruction , airway , eclampsia , intubation , anesthesia , general anaesthesia , thyroid , pregnancy , surgery , thyroidectomy , biology , genetics
In pregnancy there are changes in regulation of thyroid hormone that can affect hypothalamic pituitary thyroid axis. This goitrogenic stimulation can lead to enlargement of thyroid gland. We present a case of 37-year-old woman gravida 4, para 3 at 27-week gestation, who was referred for management of a huge multinodular goitre with impending upper airway obstruction. Severe pre-eclampsia made airway narrower due to oedema at pharyngeal and glottic region. In case of no life-threatening airway, surgery can be electively performed after delivery as to avoid preterm labour. However, if emergency lower segment caesarean section is needed, preferably it to be done under regional anaesthesia in severe preeclampsia cases. If this fails, general anaesthesia may be required with awake fiberoptic, jet ventilation and bronchoscopy standby in case of difficult intubation due to constricted airway. Our patient underwent emergency lower segment caesarean section under spinal anaesthesia at 31 weeks gestation due to severe pre-eclampsia. Right hemithyroidectomy was done three months postnatal. Obstructive symptoms resolved after operation.International Journal of Human and Health Sciences Vol. 05 No. 04 October’21 Page: 514-518