Cardiogenic Shock Secondary to Thyroid Goiter Case Report

Abstract

1.1 Background: Thyroid goiter can appear in some developing countries, related with iodo deficiencies. The main complications associated with goiter is airway obstruction, but cardiogenic shocks have not been reported previously. 1.2 Case: We report the case of a 59 year-old woman who comes to general surgery consultation for an anterior cervical mass associated with weakness, fatigue, and relative incapacity to complete her activities. At physical exam a thyroid goiter was suspected and ultrasound confirms this. Symptomatology was attributed to thyroid function disturbance and hormonal levels of TSH, T3 and T4 were confirmed as normal. Preoperative evaluation by Internal Medicine service was requested. One week later patient come to this evaluation with increased symptomatology, pallor, bradycardia, tachypnea, and parents refers a syncope too. At physical exam she was diaphoretic, with Glasgow of 12 points, pallor, cardiac frequency of 40 beats per minute and arterial pressure of 80/40mmHg, yugular ingurgitation, dyspnea, tachypnea of 27 breaths per minute, diminished peripheral pulses and distal cyanosis. CT scan refers a compressive mass dependent of left thyroid hemisphere without occlusion of airway and we appreciate a compression of left carotid artery. Patient does not improve with medical management and a cardiogenic shock secondary to carotid sinus stimulation was suspected, reason why an emergency thyroidectomy was scheduled. Hemi-thyroidectomy was completed without complications and after 24 hours’ patient was recovered and asymptomatic, confirming our suspects. 1.3 Conclusion: This case is a very rare presentation of multinodular thyroid goiter, without previous similar reports, but with high relevance to consider it in a similar scenario because the delate in urgent surgical management could worsen outcomes.