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Abstract: Auntie Zhao, 59 years old, came to the hospital 1 week ago with a sudden enlargement of the left side of her neck with a feeling of distension and slight pressure. She had a history of thyroid nodules for more than 5 years, no previous hypertension, no diabetes mellitus, no coronary heart disease, and after neck palpation and ultrasound examination, the preliminary diagnosis was thyroid occupancy, and the pathological result after surgery was non-toxic nodular goiter with cystic changes. After partial thyroidectomy on the left side, Auntie Zhao recovered smoothly, with no hoarseness and no choking cough when drinking water, and was discharged from the hospital in good condition.
Basic information】Female, 59 years old
Disease Type】Non-toxic nodular goiter with cystic degeneration
Hospital】Harbin First Hospital
Date of consultation】June 2021
Treatment plan】Surgical treatment (partial thyroidectomy on the left side)
Treatment period】5 days in hospital
Results】No hoarseness, no choking and coughing after surgery, good healing of neck incision
I. Initial consultation
The patient, Auntie Zhao, 59 years old, was seen in the outpatient clinic. At first sight, Auntie Zhao’s left neck mass was obviously bulging. One week ago, the left side of her neck suddenly increased in size with a feeling of distension, but she did not think it was serious and did not pay attention to it.
Auntie Zhao did not have hypertension, diabetes, or coronary heart disease in the past. On examination of the neck: the neck was asymmetrical, and two masses could be seen on the left side of the neck, the larger one about the size of a duck egg yolk, which was partially cystic on palpation. Auntie Zhao reported that she felt a slight sense of pressure, her breathing was normal, her voice was not hoarse, and she did not choke on water. Auntie Zhao was given a complete ultrasound examination of the neck, which showed: a nodule in the right lobe of the thyroid gland (TI-RADS class 3), a cystic mass in the left lobe of the thyroid gland (TI-RADS class 3), a mass in the isthmus of the left lobe of 3.9×2.6 cm, and another mass in the left lobe of 5.3×3.9 cm.
Auntie Zhao indicated that there was pressure on the neck mass, and the ultrasound showed that the largest mass was about 5×4cm. Considering the sudden increase of the mass, there might be symptoms of intracapsular hemorrhage, and the mass was not excluded from the possibility of malignancy, the treatment could be surgical excision, and Auntie Zhao and her family agreed, so she was diagnosed as “thyroid occupancy” and admitted to our department.
II. Treatment process
Auntie Zhao’s thyroid function was normal, no hyperthyroidism symptoms, no functional changes in the thyroid gland, and rapid intraoperative pathology showed: 1. non-toxic nodular goiter; 2. non-toxic nodular goiter with cystic changes, with bruising visible in the capsule. The swelling was not a malignant lesion, so it was decided to perform a partial thyroidectomy on the left side. Auntie Zhao recovered smoothly after surgery, with no hoarseness of voice and no choking cough when drinking, and she was hospitalized for a total of 5 days. The incision healed and Auntie Zhao was discharged.
Treatment effect
Auntie Zhao felt that her neck was much more relaxed and she could breathe freely after the operation. Auntie Zhao recovered smoothly, with no swelling in her neck, normal breathing, no wheezing and no feeling of pressure. The incision was changed on the 3rd postoperative day, and there was no redness or swelling, no exudation, the incision healed well, and the thyroid function value was within the normal range. During the postoperative course, there was no fever, no choking and coughing when drinking water, no hoarseness, and good healing of the incision.
Precautions
I am very pleased that Auntie Zhao’s condition improved and was discharged from the hospital. At the same time, I would like to advise Auntie Zhao to pay attention to a light diet after surgery, avoiding too much greasy diet, with soft and easily digestible food, such as steamed buns, rolls and noodles as the main food; eat more vegetable foods, such as cabbage and spinach; eat more vitamin-rich fruits, such as apples, bananas, oranges and dragon fruit, which are beneficial to the healing of the incision; in addition. The intake of protein, such as eggs and meat, can be increased.
In addition, it is important to take rest and avoid strenuous exercise to avoid incision cracking. Pay attention to re-check thyroid function and monitor changes in thyroid hormone levels.
V. Personal insight
In this case, Auntie Zhao has a 5-year history of previous thyroid nodules. Thyroid nodules are usually relatively stable and do not enlarge much in a short period of time, but one of Auntie Zhao’s nodules suddenly enlarged in a short period of time, and it is mostly considered that the nodule is enlarged with intracapsular hemorrhage bulge.
According to the ability of nodular goiter to secrete thyroid hormone on its own, it can be divided into non-toxic nodular goiter and toxic nodular goiter. Non-toxic nodular goiter is a benign disease, combined with the case of Auntie Zhao, which belongs to non-toxic nodular goiter, the nodule has no function to secrete thyroid hormone on its own and does not cause hyperthyroidism.
For the treatment of non-toxic nodular goiter, those with no clinical symptoms and normal thyroid function can be followed up and observed. For larger nodular goiters or those with symptoms of pressure or affecting work life, the possibility of malignancy is considered and active surgery is required.