Large goiter prolapsed on man's chest

Ho Chi Minh City Mr. Linh, 63 years old, went to see a lung doctor and suddenly discovered a large goiter that had fallen below his chest, compressing blood vessels and other organs.

Mr. Linh has smoked for more than 30 years and has chronic obstructive pulmonary disease (COPD). In February, he felt tired and had difficulty breathing. The old prescription medication did not help. He went for a lung exam and was surprised to discover a large left-sided thyroid nodule (7.6 x 6 x 6 cm, weighing 0.7 kg). The large nodule hung down his chest, slightly shifting the trachea to the right, compressing the blood vessels and surrounding organs.

He had never had a goiter before, and had no symptoms of thyroid disease such as palpitations, sweating, or bulging eyes. His neck did not appear to be swollen or unusually large.

On March 21, MSc. Dr. Le Thi Ngoc Hang, Department of Cardiovascular and Thoracic Surgery, Ho Chi Minh City Heart Center, said that if not detected and treated, the tumor will increase in size, push the trachea and esophagus to one side, compressing important surrounding organs, making it difficult for the patient to breathe, swallow, and have difficulty with surgery.

Chest CT image shows a goiter prolapsed into the mediastinum. Photo: Tam Anh Hospital

Master, Doctor Tran Thuc Khang, Department of Cardiovascular and Thoracic Surgery, Ho Chi Minh City Heart Center, assessed that the tumor was too large, located right in front of the aorta, tightly attached to neighboring tissues and organs, so there was a high possibility that the sternum would have to be cut open to remove the tumor. The team approached the tumor from the neck as usual, and if that failed, they would split the sternum.

The doctor made a 6cm incision in the neck, carefully dissecting the tumor to avoid puncturing the trachea and esophagus, not tearing large blood vessels, reducing the risk of blood loss and infection.

After nearly 4 hours, the entire tumor was removed without opening the chest. Pathology results confirmed that the tumor was benign. He was discharged from the hospital three days later, without experiencing the common complications after thyroid surgery such as bleeding, difficulty breathing, infection, voice changes, numbness in the limbs, and hypothyroidism.

Doctor Hang and the surgical team removed the patient's thyroid tumor. Illustration: Ha Vu

Goiter is an enlarged thyroid gland, usually benign, that affects many people. The thyroid gland usually grows towards the front or side of the neck. If the thyroid gland grows below and passes through the thoracic opening into the chest cavity, it is called a mediastinal goiter or substernal goiter.

Mediastinal goiter is usually diagnosed after age 50 and is four times more common in women than in men, according to Dr. Hang. Most cases do not show symptoms. As the goiter grows larger, it compresses and pushes the trachea, narrowing the airway, causing difficulty breathing during exertion, choking, coughing, and wheezing. These symptoms can easily be confused with respiratory diseases. If the patient is not prescribed a chest X-ray or CT scan, it is difficult to detect the tumor.

After surgery to remove goiter, patients need to pay attention to properly cleaning the surgical wound to avoid infection, limit talking, avoid speaking loudly to avoid damaging the vocal cords. Patients should not carry heavy objects or perform strong movements that increase pressure on the neck area where the surgical wound is, eat soft and easy-to-swallow foods, avoid sour, spicy, hard, and difficult-to-digest foods. Follow the follow-up schedule to check the surgical wound, hormone levels, and health status. If there are signs such as high fever, discharge, heavy bleeding, severe surgical wound pain, etc., patients should go to the hospital early for examination.

Most cases of benign goiter can be prevented by a diet rich in iodine. Everyone should increase their intake of sea fish, fish sauce, iodized salt... and avoid cabbage, Chinese cabbage, celery (foods that have anti-thyroid properties, preventing the thyroid gland from absorbing iodine); adhere to a healthy lifestyle (do not stay up late, limit alcohol and beer consumption, do not smoke, exercise at least 30 minutes a day).

Thu Ha

* Patient name has been changed

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