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Bleeding esophageal varices caused by Graves' hypervascular cervical goiter
The Japanese Journal of Surgery
|September 1, 1986
Summary
Graves disease can cause rare esophageal varices through a vascular goiter. Surgical removal of the goiter (total thyroidectomy) successfully stopped the bleeding from these varices.
Area of Science:
- Endocrinology
- Gastroenterology
- Vascular Surgery
Background:
- Graves' disease, an autoimmune disorder, can lead to significant thyroid enlargement (goiter).
- Thyroid goiters, particularly vascular ones, can have unique venous drainage pathways.
- Esophageal varices are typically associated with liver disease but can arise from other venous abnormalities.
Observation:
- A 65-year-old woman with recurrent Graves' disease goiter presented with hematemesis.
- Angiography identified bleeding esophageal varices originating from a vein draining the vascular goiter.
- This suggests an unusual route of venous collateral formation and gastrointestinal bleeding.
Findings:
- Total thyroidectomy was performed to address the recurrent goiter.
- Post-operatively, the esophageal varices resolved, and hematemesis ceased.
- This indicates a direct causal link between the vascular goiter and the esophageal varices.
Implications:
- Total thyroidectomy can be an effective treatment for esophageal varices secondary to a vascular goiter.
- Highlights the importance of considering rare vascular complications in patients with large or vascular goiters.
- Suggests a potential role for vascular imaging in evaluating unexplained upper gastrointestinal bleeding in specific goiter cases.