Endocrine Abstracts

An 88 year old female presented with gradually worsening stridor and dysphagia. Her past medical history was complex and included included ischaemic heart disease and atrial fibrillation treated with warfarin. She had been initially referred for enlargement of her lonstanding goitre 6 years ago (2012) with investigations demonstrating a suppressed TSH and a normal FNA cytology. Respiratory function tests did not show any significant extra thoracic compression, but her CT scan confirmed a large goitre with retrosternal extension, tracheal deviation and narrowing (see image). Although surgery was considered, in view of her multiple medical comorbidities, she underwent radioiodine treatment as she had been relatively asymptomatic. There was limited improvement in the goitre size but her thyroid function normalised. In 2017, she re-presented with a gradual increase in the size of her goitre associated with new onset stridor and dysphagia. In view of her comorbidities, anti coagulation, and the risks of surgery, she had tracheal stenting which successfully improved her symptoms. Diffusely enlarged thyroid glands can cause compressive symptoms involving the trachea, oesophagus and recurrent laryngeal nerve. These symptoms are usually treated with surgical removal of all or part of goitre which not only requires high level of expertise but may also lead to significant complications. In elderly patients with multiple comorbidities, tracheal stenting could be considered as a useful alternative to surgery or radio-iodine.