Duhamel A, Grevent D, Nouyrigat V, Cheron G
Service des urgences pédiatriques, hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France.
Arch Pediatr. 2013 Jun;20(6):661-4. doi: 10.1016/j.arcped.2013.03.026. Epub 2013 Apr 30.
We report the case of a patient who presented dyspnea due to a large intrathoracic goiter. This patient had congenital hypothyroidism due to thyroid enzyme deficiency. He came to a pediatric emergency department for dyspnea. At home, he had inspiratory and expiratory dyspnea with a stridor. No signs of respiratory distress were observed. The neck was deformed by a large goiter. The patient indicated that he did not follow the recommended L-thyroxine treatment. Chest and neck radiography showed tracheal compression. A cervical CT scan showed a 60% reduction of the tracheal caliber. To our knowledge, only one case report of goiter with tracheal compression due to congenital hypothyroidism has been reported in the literature. In the case of retrosternal goiter, dyspnea is more common than respiratory distress. Absence of tachypnea or use of accessory muscles does not exclude an anatomic compression. In the case of dyspnea, the search for a goiter is recommended.
我们报告了一例因巨大胸内甲状腺肿导致呼吸困难的患者病例。该患者因甲状腺酶缺乏患有先天性甲状腺功能减退症。他因呼吸困难来到儿科急诊科。在家时，他有吸气性和呼气性呼吸困难并伴有喘鸣。未观察到呼吸窘迫的迹象。颈部因巨大甲状腺肿而变形。患者表示未遵循推荐的左甲状腺素治疗。胸部和颈部X线检查显示气管受压。颈部CT扫描显示气管管径缩小60%。据我们所知，文献中仅报道过一例因先天性甲状腺功能减退症导致甲状腺肿压迫气管的病例报告。对于胸骨后甲状腺肿，呼吸困难比呼吸窘迫更常见。呼吸急促或使用辅助呼吸肌的缺失并不排除解剖学压迫。在出现呼吸困难的情况下，建议排查甲状腺肿。
