PSAT333 Case Of a Large Adenomatoid Hyperplastic Thyroid Goiter

Abstract

Abstract An 81-year-old woman presented to the emergency department for evaluation of shortness of breath, dysphagia and chest tightness. In the emergency department, imaging was obtained, with CXR showing complete opacification of R hemithorax. Follow up imaging with CT Chest showed large mediastinal mass contingent with the right lobe of the thyroid, along with large volume (transudative) pleural effusion. Patient underwent thoracentesis with improvement in her shortness of breath, but chest tightness persisted. IR biopsy was obtained, which confirmed the mass was indeed thyroid in origin. At this time, Endocrinology was consulted for concerns of thyrotoxicosis, along with the goiter, as lab work returned with suppressed TSH (<0.01 mcIU/mL), normal Free T4 (1.14 ng/dL). On examination, the Endocrinology team found the patient to be clinically euthyroid, with normal vital signs and only ongoing complaints of chest tightness with deep inspiration. Decision was made to go forward with resection of the mass, with a multidisciplinary approach involving ENT and Cardiothoracic Surgery. The ENT team began the procedure by dissecting the right lobe from the remaining thyroid tissue. The gland was noted to track inferiorly and posteriorly into the chest, and the decision was made to truncate the portion of the gland superior to the clavicle. At the time it was felt that further manipulation of the gland was a high risk from this position. The patient was then handed off to the cardiothoracic surgery team who, using robotic assistance, took a transdiaphragmatic approach. After roughly 3 hours of dissection, the goiter was placed in an endo-catch bag and was able to be removed through a transabdominal/diaphragmatic incision. The remainder of the left lobe was safely left in place. In the end the removed portion of the goiter was found to be 13.7 cm in length and weighed 532 g. Average thyroid weight in iodine replete populations remains roughly 20 g. Pathology returned as adenomatoid hyperplasia in all 4 specimens. Postoperatively the patient did well and follow up with Endocrinology was scheduled. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.