An adult's thyroid gland is normally the size of a chestnut. But 77-year-old Granny Ke, her thyroid gland is actually swollen like 3 "big mangoes", and the lump will press the trachea to severe stenosis, the narrowest part is only 3.8 mm, and she may be suffocated by the "throat seal" at any time. At the critical moment, the Department of Breast and Thyroid Surgery of the People's Hospital of Wuhan University (Hubei Provincial People's Hospital) led a multidisciplinary collaboration to remove the huge mass in time and successfully saved lives.
Granny Ke, 77, from Yichang, Hubei Province, found a lump in her neck for more than 10 years but did not treat it. A year ago, she went to the hospital for an enlarged mass, but the local hospital considered that her mother-in-law was old, only 1.4 meters tall, and had a history of hypertension and hyperthyroidism, and that anesthesia and surgery were very risky, and recommended conservative treatment.
Who knew that in the past six months, the "small pimple" on the neck has rapidly grown to the size of 3 "mangoes", which seriously affects breathing and swallowing. Seeing that the situation was urgent, the family took her mother-in-law to the Department of Breast Nail Surgery of the People's Hospital of Wuhan University for help.
After receiving the consultation, Zhu Shan, deputy chief physician of the Department of Breast Nail III, found that Granny Ke was suffering from a huge retrosternal goiter with a maximum diameter of more than 13 cm. The large mass is tightly adhered to the surrounding tissues, compressing the trachea to a severe stenosis, only 3.8 mm at its narrowest point, and the mass has grown into the thoracic cavity and extends to the retrosternal bone, close to the aortic arch, and surgical treatment is extremely risky.
Professor Wang Long, deputy director of the Department of Anesthesiology, said that severe stenosis of the trachea like Granny Ke is rare, and pain in the right shoulder has occurred in the past 3 days, which may be caused by the rapid enlargement of the thyroid gland on the right side compressing the brachial plexus. If the lump grows a little longer, or if it is blocked by a small mouthful of phlegm, it can easily cause suffocation. If surgery is not performed in time, the enlarged thyroid gland will completely close the trachea, and it can be life-threatening at any time.
Although anesthesia and surgery are extremely risky, the trust of patients and families gives doctors the courage to take risks. Before the operation, the Department of Breast Nail III combined with the Department of Anesthesiology, Respiratory Medicine, Otolaryngology, Radiology, and other multidisciplinary experts consulted, and Professor Wei Wen of the Department of Breast Nail III repeatedly checked the patient's CT to evaluate the relationship between the mass and the surrounding important structures, and constantly simulated the possible scenarios during the operation, and the "think tank" formulated multiple sets of emergency plans.
In order to ensure the safety of the patient's operation to the greatest extent, Professor Wang Long, deputy director of the Department of Anesthesiology, said that the patient must be awake for endotracheal intubation. Due to the significant compression and stenosis of the airway due to the large mass, there may still be difficulty in endotracheal intubation or asphyxia due to intubation failure, but this is necessary to determine the success or failure of the procedure. Professor Wang Long led the team to design a dual-channel breathing circuit of jet ventilation and endotracheal tube according to the mother-in-law's situation, so as to ensure successful ventilation and ensure the safety of the mother-in-law's life to the greatest extent.
On the day of the operation, when the mother-in-law was fully awake, Professor Wang Long of the Department of Anesthesiology led Deputy Chief Doctor Liu Kang to successfully insert the "lifeline" - neuromonitoring tracheal catheter in the narrow airway, and the depth of intubation crossed the narrowest part of the airway to ensure oxygen supply. At the same time, the patient's vital signs were closely monitored during the operation to ensure the smooth progress of the operation.
Professor Wei Wen's team skillfully ligated and delicately operated on the dense dilated blood vessels, which not only completely removed the goiter but also protected the surrounding important tissues, with minimal intraoperative bleeding. With the coordination of the surgical and anesthesia medical teams, the mother-in-law successfully "defused the bomb".
After waking up from anesthesia after surgery, Granny Ke suddenly felt that her breathing was smooth, and she was about to suffocate after being tortured by a huge mass, and she was finally able to breathe freely again, and her neck immediately "became thinner". Granny Ke not only removed the heavy burden on her neck, but also removed the big stone in her heart, and the problem that had plagued her for many years was finally solved, and Granny Ke's family was grateful to the doctors.
Source: People's Hospital of Wuhan University (Hubei Provincial People's Hospital)
Correspondent: Liu Yu
Editor: Huang Menglin
Reviewer: Chen Shirui
Issued: Daley Red
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