Endoscopic thyroidectomy to minimize light exposure of an erythropoietic protoporphyria patient: A case report

Abstract

Introduction and importanceErythropoietic protoporphyria is a rare form of cutaneous porphyria that presents with photosensitivity. During surgery, light shielding is required to prevent acute attacks due to photosensitivity. In this study, we report a case of successful endoscopic thyroidectomy using video-assisted neck surgery (VANS) method for a thyroid tumor in a patient with erythropoietic protoporphyria.Case presentationA 32-year-old woman with a history of erythropoietic protoporphyria and an enlarged left thyroid gland was referred to our hospital. The referring physician had noted a left lobe tumor of the thyroid gland with a maximum diameter of 5 cm. Computed tomography and ultrasonography showed the tumor shape as smooth and well-defined. A lobectomy of the thyroid gland was performed using the VANS method through a 3-cm incision on the skin. Surgical light was not used and exposure to ambient light was minimized by covering the patient's neck with a drape. No acute attack of porphyria or photosensitivity was observed during the surgery or the follow-up. Postoperative complications such as asphyxia, blood loss, or nerve palsy were absent. The patient was discharged 5 days after the surgery.Clinical discussionWhile the VANS method is known to have mainly cosmetic advantages, this case demonstrates that it is also a method that can minimize the exposure of the patient's skin to light with using an additional drape.ConclusionThe VANS method should be considered as an option for thyroidectomy in patients with protoporphyria because it can reduce the exposure to light during surgery.