Riedel’s Thyroiditis: Pitfalls in Diagnosis and Subsequent Complications

Riedel’s thyroiditis is a rare disease of chronic inflammation with fibrotic infiltration of the thyroid gland and its surrounding vital structures. Due to its low incidence, there are often delays in diagnosis as it is commonly mistaken for other thyroid diseases. We report the case of a 34-year-old female patient who presented with a firm, enlarged mass in the neck, compression symptoms, and hypothyroidism. Lab tests showed elevated A-TG (thyroglobulin antibodies) and A-TPO (thyroid peroxidase antibodies) levels. Based on the disease presentation and supporting lab findings, the patient was misdiagnosed with Hashimoto’s thyroiditis and treated accordingly. Yet the patient’s symptoms grew progressively worse. She was discovered to have severe tracheal compression and bilateral RLN (recurrent laryngeal nerve) palsy. Tracheotomy became a necessary surgical intervention after the development of respiratory failure, but this procedure was complicated by the development of an intraoperative pneumothorax. After an open biopsy, histology revealed Riedel’s thyroiditis. A new treatment was introduced, with which the patient’s condition improved. However, she continued to suffer from the open tracheocutaneous fistula left by the tracheostomy, which adversely affected her everyday life. A follow-up operation was performed to close the fistula. In this case report, we discuss the consequences of misdiagnosing the patient and delaying the appropriate treatment for her disease

Интраоперативна ятрогенна лезия на нервус ларингеус рекуренс и възстановяване целостта му с Prolene 7.0 - клиничен случай

Ларингеалната дисфункция след тиреоидектомия е честа компликация. Парезата на нервус ларингеус рекуренс (НЛР) се нарежда сред водещите причини за медико-правни съдебни процеси срещу хирурзи в САЩ и ЕС. Основание за това е съпътстващото нарушаване качеството на живот при пациента. Съобщаваме за 57-годишна пациентка с голяма рецидивна полинодозна струма. Болната е оперирана на 16.06.2008 в обем почти тотална тиреоидектомия. Извършена е билатерална идентификация и дисекция (невролиза) на рекурентните нерви. По време на невролизата е прекъсната целостта на левия НЛР и същият е въз становен посредством сутура с Prolene 7.0.Хирургическата намеса е документирана с помощта на дигитална камера. Гласовата функция на пациентката е записана на 5 час, 24 час и 3 месеца постоперативно.Една седмица след изписването при пациентката е извършена ларингостробоскопия в Сектора по фониатрия на УМБАЛ „Царица Йоанна-ИСУЛ“ – диагностицирана пареза на лява истинска гласна връз ка. Пациентката е подложена на гласова рехабилитация. На 14. месец след тиреоидектомията резултатът от стробоскопията е невъзстановена функция на лява гласна връзка вследствие на перманентна пареза на левия НЛР.Заключение: Интраоперативното възстановяване посредством сутура на прекъснат рекурентен нерв възстановява анатомично, но не и функционално нерва. Идентифицирането и последваща невролиза на НЛР са златният стандарт в тиреоидната хирургия. Това е най-добрата гаранция за запазване гласовата функция при болния.-----------------------------------Background: Laryngeal dysfunction after thyroidectomy is a common complication. Recurrent laryngeal nerve (RLN) palsy ranks among the leading reasons for medicolegal litigation of surgeons in USA and EU, because of its attendant reduction of quality of life. Case report: We report about 57-year-old female patient with big recurrent multi-nodular thyroid goiter. The patient was operated on 16.06.2008 – Near-total thyroidectomy et Visual bilateral Recurrent laryngeal nerve identification and preparation without the use of intraoperative nerve monitoring. During the preparation the left RLN has been damaged and a suture with Prolene 7.0 was performed.The surgical procedure was documented by camera. The patients voice function was recorded 5 hours, 24 hours and 3 months postoperatively. An postoperative laryngostroboscopic examination was performed 1 week after discharge. The patient underwent voice rehabilitation for a RLN paresis and was followed at the ENT- Phoniatric department.Conclusion: Intraoperative suture of the injured laryngeal nerve bring less benefit for the RLN dysfunction

Minimally Invasive Radiofrequency Ablation for Large Thyroid Toxic Adenoma

Background: Most thyroid nodules are benign and do not need intervention. Toxic adenoma and toxic multinodular goiter (MNG) are common causes of hyperthyroidism, second in prevalence only to Graves’ disease. Toxic adenoma and MNG are the result of focal or diffuse hyperplasia of thyroid follicular cells whose functional capacity is independent from regulation by the thyroid stimulating hormone (TSH). When conservative treatment modalities fail to ensure an euthyroid state, surgical intervention is required, typically surgical left or right thyroid lobectomy. Radiofrequency ablation (RFA) is a new percutaneous treatment option that results in thermal tissue necrosis and fibrosis. As a result of this process, the thyroid nodules shrink