Benign Goiter with Superior Vena Cava Syndrome

Abstract

Primary hyperparathyroidism (HPT) is treated by parathyroidectomy. Excision of abnormal parathyroid tissue is curative in the majorityof cases. Postoperative persistent or recurrent HPT has been reported up to 30%. The purpose of this study was to evaluate the role ofimaging techniques and determine the efficacy of reexplorative surgery. A total of 306 patients underwent parathyroidectomy between2000 and 2009. Twelve patients (3.9%) were not cured. Two patients declined further treatment, the other 10 patients underwent furtherinvestigation and surgery. Imaging and results of redo surgery together with associated complications were evaluated. All 10 patientswere investigated with sestamibi, which accurately localized aberrant parathyroid tissue in three cases and ultrasound scans which alsolocalized three cases. CT was useful in one of the three cases for which it was used. PET and MRI were not helpful. Twelve glands wereresected, six adenomas, five hyperplastic and one normal gland. Nine of the 10 reoperated patients became normocalcemic. Complicationsincluded a bilateral recurrent laryngeal paresis. In total, 317 operations were performed and 303 of 306 (99%) patients were cured. Redosurgery for HPT is challenging and carries higher risks than primary surgery. Sestamibi and ultrasound scans are the most helpfulimaging modalities. When there is concordance a targeted approach may be considered, otherwise a more extensive dissection isrequired. Redo parathyroid surgery should be considered, even if scans are unhelpful, for patients who are symptomatic or young orhave a persistently high calcium level.

Full text

Transoral Excision of a High Retropharyngeal Parathyroid
World Journal of Endocrine Surgery, September-December 2011;3(3):151 151
WJOES
Benign Goiter with Superior Vena Cava Syndrome
1Anand Kumar Mishra, 2S Tewari
1Assistant Professor, Department of Surgery, CSM Medical University (Earlier King George’s Medical College), Lucknow, Uttar Pradesh, India
2Associate Professor, Department of Surgery, CSM Medical University (Earlier King George’s Medical College), Lucknow, Uttar Pradesh, India
Correspondence: Anand Kumar Mishra, Assistant Professor, Department of Surgery, CSM Medical University (Earlier King
George’s Medical College), Lucknow, Uttar Pradesh, India, e-mail: mishra101@gmail.com
ENDOCRINE IMAGE
CASE HISTORY
A 46-year-old lady presented in emergency with respiratory distress, voice change and inability to take food (Fig. 1). She had a
long-standing goiter of 20 years duration with slow progression. She was investigated in 2001 by a general surgeon and was
found to be biochemically euthyroid with a cytology of colloid goiter. She was not advised to seek surgical treatment and since
then her problems continued to increase albeit slowly but surely. When she presented to us, she was anxious looking with pulse
rate of 96/minute and respiratory rate of 40 per minute. She had a huge goiter with dilated veins over the goiter as well as on
anterior chest and the lower border could not be felt. After admission, she was given hydrocortisone 200 mg stat followed by
dexamethasone 8 mg IV three times, broad-spectrum antibiotics and humidified oxygen inhalation by nasal prongs @ 6 liters/
minute. Her ABG showed type I failure at admission with acidosis. Unfortunately, while she was being resuscitated and being
optimized for surgery, she expired within 32 hours of admission.
Fig. 1: Patient presenting with large goiter and dilated veins over the neck and anterior chest wall
suggestive of thoracic inlet syndrome
10.5005/jp-journals-10002-1080