ABSTRACT
A 42-year-old male pediatrics physician was admitted with a history of acute chest pain and sudden severe dysphagia to solids and liquids. He denied any history of abdominal pain, vomiting, dyspnea, nausea weight loss. He could not even swallow saliva. The patient denied any history of drug abuse. A computed tomographic scan of the chest (CT)showed a posterior mediastinal mass inseparable from the esophagus and descending aorta. Magnetic resonant imaging (MRI)scan revealed a cystic mass full of blood inseparable from the esophagus and adherent to the aorta. The mass was resected entirely through the left thoracotomy; post-operative recovery was uneventful; dysphagia resolved as the post-operative contrast swallow study showed a free flow of contrast to the stomach patient resumed his regular diet.
ABSTRACT
Hashimoto thyroiditis (HT) is an autoimmune disorder characterized by inadequate thyroid hormone production. A fibrous variant is one of the rarest entities of Hashimoto's thyroiditis disease. A 42 -year-old female patient presented to our service with neck swelling associated with difficulty swallowing; she was discovered to have an enlarged thyroid gland with mass effect. She underwent an ultrasound and fine-needle aspiration (FNA), which was consistent with Hashimoto's thyroiditis -Bethesda category II-. Due to compressive symptoms, we proceeded to total thyroidectomy. The final histopathology revealed numerous polymorphic lymphoid cells, plasma cells, follicular cells, and scattered Hürthle cells, characteristic of fibrous variants. The surgery was complicated with voice hoarseness and hypocalcemia, which was managed successfully with corticosteroids and calcium supplements. The mainline treatment of HT is medical, but surgical intervention can be considered in some cases. A multidisciplinary approach is needed for successful management. Continuous patient monitoring post-operatively is vital to detect and intervene with early surgical complications.
