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      Difficult airway management and emergency tracheostomy in a patient with giant goiter presenting with respiratory arrest: A case report

      case-report
      Author(s):
      Publication date (Electronic):
      Journal: Experimental and Therapeutic Medicine
      Publisher: D.A. Spandidos
      Keywords: giant goiter, difficult airway, thyroidectomy, tracheostomy, tracheomalacia

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          Abstract

          Giant goiter is commonly asymptomatic or progresses with nonspecific symptoms, such as pain, hoarseness and dysphagia. In rare cases, enlargement of the thyroid may cause compression of the trachea and lead to life-threatening complications. As a result of iodization programs implemented throughout the world to address iodine deficiency disorders, giant goiter is rare today. Although not common, the disease may result in a difficult airway in cases of tracheal compression. The present study shares our experience of a giant retrosternal goiter in a patient presenting with respiratory arrest who underwent emergency tracheostomy after multiple attempts at orotracheal intubation and then thyroidectomy during an intensive care stay due to the development of tracheomalacia.

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          Guidelines for the management of tracheal intubation in critically ill adults

          A Higgs, B.A. McGrath, C. Goddard … (2018)
          These guidelines describe a comprehensive strategy to optimize oxygenation, airway management, and tracheal intubation in critically ill patients, in all hospital locations. They are a direct response to the 4th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society, which highlighted deficient management of these extremely vulnerable patients leading to major complications and avoidable deaths. They are founded on robust evidence where available, supplemented by expert consensus opinion where it is not. These guidelines recognize that improved outcomes of emergency airway management require closer attention to human factors, rather than simply introduction of new devices or improved technical proficiency. They stress the role of the airway team, a shared mental model, planning, and communication throughout airway management. The primacy of oxygenation including pre- and peroxygenation is emphasized. A modified rapid sequence approach is recommended. Optimal management is presented in an algorithm that combines Plans B and C, incorporating elements of the Vortex approach. To avoid delays and task fixation, the importance of limiting procedural attempts, promptly recognizing failure, and transitioning to the next algorithm step are emphasized. The guidelines recommend early use of a videolaryngoscope, with a screen visible to all, and second generation supraglottic airways for airway rescue. Recommendations for emergency front of neck airway are for a scalpel-bougie-tube technique while acknowledging the value of other techniques performed by trained experts. As most critical care airway catastrophes occur after intubation, from dislodged or blocked tubes, essential methods to avoid these complications are also emphasized.
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            Iodine deficiency and thyroid disorders.

            Michael Zimmermann, Kristien Boelaert (2015)
            Iodine deficiency early in life impairs cognition and growth, but iodine status is also a key determinant of thyroid disorders in adults. Severe iodine deficiency causes goitre and hypothyroidism because, despite an increase in thyroid activity to maximise iodine uptake and recycling in this setting, iodine concentrations are still too low to enable production of thyroid hormone. In mild-to-moderate iodine deficiency, increased thyroid activity can compensate for low iodine intake and maintain euthyroidism in most individuals, but at a price: chronic thyroid stimulation results in an increase in the prevalence of toxic nodular goitre and hyperthyroidism in populations. This high prevalence of nodular autonomy usually results in a further increase in the prevalence of hyperthyroidism if iodine intake is subsequently increased by salt iodisation. However, this increase is transient because iodine sufficiency normalises thyroid activity which, in the long term, reduces nodular autonomy. Increased iodine intake in an iodine-deficient population is associated with a small increase in the prevalence of subclinical hypothyroidism and thyroid autoimmunity; whether these increases are also transient is unclear. Variations in population iodine intake do not affect risk for Graves' disease or thyroid cancer, but correction of iodine deficiency might shift thyroid cancer subtypes toward less malignant forms. Thus, optimisation of population iodine intake is an important component of preventive health care to reduce the prevalence of thyroid disorders.
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              The epidemiology of thyroid disease.

              M P J Vanderpump (2011)
              Thyroid disorders are prevalent and their manifestations are determined by the dietary iodine availability. Data from screening large population samples from USA and Europe. The most common cause of thyroid disorders worldwide is iodine deficiency, leading to goitre formation and hypothyroidism. In iodine-replete areas, most persons with thyroid disorders have autoimmune disease. Definition of thyroid disorders, selection criteria used, influence of age and sex, environmental factors and the different techniques used for assessment of thyroid function. Increasing incidence of well-differentiated thyroid cancer. Environmental iodine influences the epidemiology of non-malignant thyroid disease. Iodine supplementation of populations with mild-to-moderate iodine deficiency. An evidence-based strategy for the risk stratification, treatment and follow-up of benign nodular thyroid disease. Is there any benefit in screening adults for thyroid dysfunction?
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                Author and article information

                Journal
                Journal ID (nlm-ta): Exp Ther Med
                Journal ID (iso-abbrev): Exp Ther Med
                Journal ID (publisher-id): ETM
                Title: Experimental and Therapeutic Medicine
                Publisher: D.A. Spandidos
                ISSN (Print): 1792-0981
                ISSN (Electronic): 1792-1015
                Publication date Collection: August 2022
                Publication date (Electronic): 08 June 2022
                Publication date PMC-release: 08 June 2022
                Volume: 24
                Issue: 2
                Electronic Location Identifier: 499
                Affiliations
                Department of Intensive Care Unit, University of Health Sciences, Ankara City Hospital, 06800 Ankara, Turkey
                Author notes
                Correspondence to: Dr Hayriye Cankar Dal, Department of Intensive Care Unit, University of Health Sciences, Ankara City Hospital, 1 Bilkent Street, Cankaya, 06800 Ankara, Turkey hayriyecankar@ 123456hotmail.com
                Article
                Publisher ID: ETM-24-2-11426
                DOI: 10.3892/etm.2022.11426
                PMC ID: 9257903
                PubMed ID: 35837072
                SO-VID: 2aa1f14e-7e6e-4526-bd27-33e2309bc4dd
                Copyright © Copyright: © Cankar Dal et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                Date received : 16 April 2022
                Date accepted : 24 May 2022
                Funding
                Funding: No funding was received.
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
                Keywords: giant goiter,difficult airway,thyroidectomy,tracheostomy,tracheomalacia
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: giant goiter, difficult airway, thyroidectomy, tracheostomy, tracheomalacia

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