(Disclaimer: This article is for general use only, and the information in the following content has been processed to protect the privacy of Ms. Zhang)
Abstract: The subject of this case is a 70-year-old woman who came to our hospital with a “neck swelling”. Zhang’s mother reported that she suddenly found a bag in her neck 4 months ago and did not pay attention to it at first, but recently her symptoms worsened and affected her swallowing, so she was worried about the growth of a tumor and came to our hospital for consultation. She was worried that a tumor was growing, so she came to our hospital. Combining Zhang’s symptoms, medical history and examination results, she was considered to be a thyroid tumor. After treatment, the symptoms of dyspnea disappeared, all indicators improved, and the quality of life improved significantly.
Basic information】Female, 70 years old
Type of disease】Thyroid adenoma
Hospital】The First Hospital of Harbin Medical University
Date of consultation】February 2022
Treatment plan】Surgery (left thyroidectomy + thyroid isthmus resection) + medication (levothyroxine sodium tablets)
Treatment period】6 days of inpatient treatment, followed by 1 month of outpatient treatment
Treatment effect] The symptoms of dyspnea disappeared, all indicators improved, and the quality of life improved significantly.
I. Initial consultation
Zhang’s mother found a swelling on her left side of the neck, about the size of an egg yolk, unintentionally 4 months ago. At first, she thought it was not a big deal, but recently the swelling in her neck had increased significantly and affected her breathing and swallowing, so she came to the clinic. On examination, we found that the neck was asymmetrical and the left side of the neck showed fullness. Ultrasensitive thyrotropin: 9.5956 μIU/ml; free thyroxine: 0.94 ng/dl; free triiodothyronine: 2.78 pg/ml; peroxidase antibody: 0.33 IU/ml; thyroglobulin antibody: 0.66 IU/ml. Ultrasonography of the thyroid gland showed a solid nodule of 5.2 cm X 3.2 cm in size in the left lobe of the thyroid gland. The nodule has a clear border, regular contour, and a small amount of cystic anechoic area with an elasticity score of 2. TI-RADS classification: 4a follicular adenoma possible. In combination with Zhang’s medical history and relevant examinations, it was considered a thyroid tumor with obvious compression symptoms.
II. Treatment history
In view of the obvious compression symptoms of thyroid tumor, surgery was considered for Zhang’s tumor. After completing the thyroid CT and the necessary preoperative examination after hospitalization, the thyroid CT confirmed that the trachea was significantly displaced by the compression. After full communication with Ms. Zhang and her daughter, a thorough evaluation was performed. Despite her age, Zhang’s cardiopulmonary function was good, and the evaluation determined that she could perform the surgery under general anesthesia. Subsequently, a left thyroidectomy + isthmus resection was performed, and intraoperative rapid pathology confirmed a thyroid adenoma. The surgery relieved the local compression created by the tumor and treated the thyroid adenoma at its root. Due to the removal of the thyroid gland on one side, postoperative supplemental treatment with levothyroxine sodium tablets was required for six months. During this period again, it is necessary to follow the doctor’s prescription for review and adjust the dosage if necessary.
(Thyroid CT)
III. Treatment results
After resection of the lobe where the thyroid tumor was located, the pressure of the thyroid tumor on the trachea and esophagus and other important organs was fundamentally relieved, and the original shape of Zhang’s neck was restored, the symptoms of dyspnea disappeared, and the quality of life improved significantly. Six days after the operation, Zhang’s incision recovered well, no septicemia or infection occurred, and all indicators were improving in the re-examination, so Zhang felt well and in good condition, and was discharged from the hospital. Zhang and her family expressed satisfaction with the treatment effect. Before discharge, Zhang was asked to review her outpatient clinic in one month.
IV. Precautions
As a doctor, we are sincerely happy for Zhang and her family that the lesions were removed, the symptoms disappeared and her body gradually recovered after the surgical treatment and supplemental drug therapy. However, Zhang’s mother needs to pay attention to the following matters.
1. neck exercise: after the operation, it is recommended that Zhang’s mother perform moderate and light neck exercises to avoid the occurrence of neck incision adhesions and serious discomfort in the shoulder and neck.
2. Dietary guidance: Since Zhang’s tracheal intubation was required during the surgery, which caused certain stimulation to the trachea and throat, Zhang was advised to have a light diet for a short period of time and drink moderately more water in order to promote recovery.
3. Incision care: Zhang’s incision was changed by the doctor during her stay in the hospital, and after her discharge from the hospital, if there are no special circumstances, she usually does not need to change her own medication, but can start applying scar removal medication 1 week after her discharge.
V. Personal insight
Elderly women need to be alert to the presence of thyroid adenoma if they present with a neck swelling with obvious pressure symptoms. After the diagnosis of thyroid adenoma, if the patient is in good general condition and can tolerate general anesthesia, surgical treatment is preferred to fundamentally relieve the pressure of thyroid adenoma on important organs such as trachea and esophagus, as in this case. However, sometimes thyroid surgery can be performed if the thyroid adenoma is enlarged and seriously affects the appearance, although there are no symptoms of compression.