Deng Yuqing, Ding Guoqian
Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Front Surg. 2023 Sep 28;10:1267701. doi: 10.3389/fsurg.2023.1267701. eCollection 2023.
Horner's syndrome (HS) is a rare condition due to damage to the 3-neuron sympathetic pathway anywhere between the posterior-lateral nuclei of the hypothalamus and the oculosympathetic fiber, particularly as a post-thyroidectomy symptom. In this case report, we present a case of HS following endoscopic thyroid surgery (ETS) and briefly review the literature.
During a routine physical examination, a 29-year-old female patient was incidentally found to have multiple nodules in the right thyroid. She was subsequently admitted to the Department of General Surgery for further examinations and treatment. A fine-needle aspiration biopsy confirmed malignancy in these nodules. As a result, the patient underwent radical resection of the right thyroid and ipsilateral central lymph node dissection using endoscopy. Pathological diagnosis revealed papillary thyroid carcinoma. Unexpectedly, on the third day after the operation, the patient was diagnosed with Horner's syndrome based on the presence of miosis and ptosis. After 1 week of follow-up, the symptoms related to HS significantly improved.
Horner's syndrome is an uncommon complication of thyroidectomy in patients undergoing ETS. Therefore, it is crucial to perform careful operations and minimize iatrogenic surgical damage to reduce the incidence of HS. This case serves as a reminder that making rational judgments and implementing appropriate measures are essential for achieving a favorable prognosis and preserving facial esthetics.
霍纳综合征(HS)是一种罕见病症,由于下丘脑后外侧核与眼交感神经纤维之间的三神经元交感神经通路任何部位受损所致,尤其是作为甲状腺切除术后的一种症状。在本病例报告中,我们呈现了一例内镜甲状腺手术(ETS)后发生霍纳综合征的病例,并简要回顾相关文献。
在一次常规体检中,一名29岁女性患者偶然发现右侧甲状腺有多个结节。随后她被收入普通外科进一步检查和治疗。细针穿刺活检证实这些结节为恶性。因此,该患者接受了内镜下右侧甲状腺根治性切除术及同侧中央淋巴结清扫术。病理诊断为甲状腺乳头状癌。出乎意料的是,术后第三天,基于存在瞳孔缩小和上睑下垂,该患者被诊断为霍纳综合征。经过1周的随访,与霍纳综合征相关的症状明显改善。
霍纳综合征是接受内镜甲状腺手术患者甲状腺切除术后一种不常见的并发症。因此,进行仔细操作并尽量减少医源性手术损伤以降低霍纳综合征的发生率至关重要。本病例提醒我们,做出合理判断并采取适当措施对于获得良好预后和保持面部美观至关重要。