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Minimal Invasive Resection of Large Retrosternal Thyroid Goiter

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Recurrent thyrotoxicosis following near-total thyroidectomy.

Paul Gaschen¹, Joehassin Cordero², Alan N Peiris³

¹School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas.

Proceedings (Baylor University. Medical Center)

|February 18, 2020

Summary

Recurrent hyperthyroidism after total thyroidectomy is rare but possible. This case highlights the importance of monitoring for thyrotoxicosis recurrence even after near-total thyroid removal.

Keywords:

Graves’ disease recurrence thyrotoxicosis total thyroidectomy

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Area of Science:

Endocrinology
Surgical Oncology
Nuclear Medicine

Background:

Total thyroidectomy is a standard surgical procedure for managing hyperthyroidism, typically resulting in a cure.
Levothyroxine hormone replacement is initiated post-thyroidectomy to maintain euthyroid status.

Observation:

A 27-year-old woman presented with recurrent thyrotoxicosis approximately two years after a near-total thyroidectomy, despite levothyroxine therapy.
Diagnostic imaging revealed vascularized thyroid tissue in the right thyroid region with increased radioactive iodine uptake.

Findings:

The patient's recurrent hyperthyroidism was confirmed off levothyroxine therapy.
Ultrasound and radioactive iodine scan identified residual, functional thyroid tissue as the source of thyrotoxicosis.

Implications:

This case underscores the possibility of thyrotoxicosis recurrence after near-total thyroidectomy due to residual thyroid tissue.
It emphasizes the need for vigilant long-term monitoring of thyroid function in patients who have undergone thyroid surgery.
Management strategies may include antithyroid medication and radioactive iodine therapy for recurrent hyperthyroidism.