Garingarao Carlo Jan, Añonuevo-Cruz Cecille, Gasacao Ryan
Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of the Philippines-Philippine General Hospital, Manila, NCR, Philippines.
BMJ Case Rep. 2013 Jul 22;2013:bcr2013200027. doi: 10.1136/bcr-2013-200027.
Benign goitres have the potential to reach massive sizes if neglected, but most have a protracted course that may or may not present with compressive symptoms. We report the case of a 57-year-old man who presented with a rapidly enlarging nodular goitre resulting in acute respiratory failure. Endotracheal intubation and emergency total thyroidectomy were performed, revealing massive thyroid nodules with minimal intrathoracic extension and tracheal erosion. Despite a course and clinical findings suggestive of malignant disease, histopathology was consistent with a benign multinodular goitre. Several cases of benign goitres necessitating endotracheal intubation have been reported. Airway compromise was attributed to a significant intrathoracic component, or inciting events such as thyroid haemorrhage, pregnancy, radioiodine uptake or major surgery. Obstructive symptoms may not correlate well with objective measures of upper airway obstruction such as radiographs or flow volume loops.
良性甲状腺肿若被忽视有发展为巨大甲状腺肿的可能，但多数病程迁延，可能出现或不出现压迫症状。我们报告一例57岁男性患者，其表现为迅速增大的结节性甲状腺肿并导致急性呼吸衰竭。行气管插管及急诊全甲状腺切除术，术中发现巨大甲状腺结节，胸腔内延伸极少且有气管侵蚀。尽管病程及临床表现提示为恶性疾病，但组织病理学结果符合良性多结节性甲状腺肿。已有数例良性甲状腺肿需要气管插管的报道。气道受压归因于显著的胸腔内成分，或诸如甲状腺出血、妊娠、放射性碘摄取或大手术等诱发事件。梗阻症状可能与上气道梗阻的客观指标如X线片或流量容积环等相关性不佳。
