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A two kilograms euthyroid goiter in Singida Regional Referral Hospital, Central Tanzania: Case report
Amri A Mabewa1, Joyce Njile1, Amedeus Mushi2
1Singida Regional Referral Hospital, Tanzania; Surgery Department, Tanzania; Radiology Department, Tanzania.
Introduction:
Multinodular goiter (MNG) is a clinic pathological entity characterized by an increased volume of the thyroid gland with formation of nodules. Goiter is defined as a thyroid gland weighing over 20-25 g or with a volume of over 19 ml in women and 25 ml in men. In developed countries where iodination of food is common and health services are available and accessible, hardly will you see a goiter of up to 0.2 kg while in areas where poverty is high and health services not available, there identification of goiter of up to 4 kg. Therefore each member of theatre team must be competent and experienced to anticipate any complications which may occur during thyroidectomy of such huge goiter. Awareness on the operation of such huge multinodular goiter is the sincere aim of this work due to the fact that these are rare findings in today's surgical clinics.
Presentation Of Case:
A 35 M.O.S years old female presented with complain of swelling of the anterior neck for 10 years. Laboratory and radiological investigations reveals nontoxic multinodular goiter with no suspicion of malignance. After successful thyroidectomy, a 2 kg multinodular goiter was removed and taken for histological diagnosis. Post-operative care was uneventful and patient discharged day five post-operative. No complication observed during follow up.
Discussion:
The case report presented a patient with huge goiter of 2 kg, which was not compressing the trachea. After physical examination, radiological imaging and laboratory investigation of thyroid hormones confirm as nontoxic goiter. The subtotal thyroidectomy was successful and after follow up of 60 days there was no complication reported.
Conclusions:
Currently, hardly will you find goiter weighing a kg and thus skills for thyroidectomy in such case is hardly available. Special complications like trachealmalacia and difficult intubation which need one to be aware of fiber optic intubation and be prepared for tracheostomy require experienced operating team.