Thyroid Surgery\Severe Sequelae\Persisting for Several Years

Female, 42 years old Discharge Summary Admission time: April 2, 15:19 Discharge time: April 6, 14:00 Admission diagnosis: Thyroid tumor Discharge diagnosis: Thyroid adenoma (nodular goiter of the right thyroid) Brief history on admission: The patient noticed neck swelling six months earlier while eating and could feel a movable mass. There was no obvious enlargement, nausea, vomiting, difficulty swallowing, hoarseness, or choking on water. On August 2 of the previous year, thyroid ultrasound showed “thyroid nodule with calcification,” and she received conservative treatment. On March 18, repeat ultrasound at another hospital showed “cystic-solid nodule in the right thyroid lobe with coarse or scattered calcifications.” She was admitted for further evaluation and treatment. Since onset, the patient had been alert and oriented with normal appetite, sleep, bowel and bladder function, and no significant weight change. Physical examination: T: 36.6℃; P: 78 beats/min; R: 18 breaths/min; BP: 120/80 mmHg. Neck soft, trachea midline, no jugular venous distension, carotid pulsations normal. A 1 cm mass was palpable in the right thyroid. Main laboratory and imaging results during hospitalization: April 3: glucose 4.00 mmol/L, sodium 139 mmol/L, potassium 4.09 mmol/L, hemoglobin 124 g/L, platelet count 187 × 10⁹/L. Blood glucose, complete blood count, urinalysis, liver and kidney function, and electrolytes were otherwise unremarkable. April 3, chest radiograph (posteroanterior view): No definite active lesions in either lung. Hospital course and treatment: After admission, the patient completed relevant examinations. On April 4, she underwent right thyroid lobectomy plus isthmusectomy under general anesthesia. Intraoperative findings: right thyroid nodule approximately 1.2 cm, moderate consistency; left thyroid unremarkable; no enlarged lymph nodes identified. Frozen section: nodular goiter of the right and left thyroid. The patient recovered well postoperatively and received routine anti-inflammatory and intravenous fluid support. At discharge she was alert, oriented, with normal bowel and bladder function, stable vital signs, and in good general condition. Treatment outcome: Discharged

Frozen and Paraffin Pathology Report Specimen date: April 4 Department: Surgery I Gross examination: Right thyroid: 4.5 × 3 × 1.2 cm; cut surface showed a 1.5 cm nodule with clear borders, gray-red, soft consistency. Isthmus: 2.1 × 1 × 0.3 cm, no obvious nodule. Microscopic examination: Pathological diagnosis: “Right” nodular goiter with focal papillary microcarcinoma (0.1 cm, seen on paraffin section). “Isthmus” nodular goiter. Remarks: Immunohistochemistry and special stains: none

Nuclear Medicine SPECT/CT Report Examination date: August 21 of the following year Clinical diagnosis: Procedure: Static acquisition after intravenous 99mTcO4- Findings: Left thyroid visualized; post right thyroid cancer surgery, focal abnormal radiotracer uptake in the right thyroid bed. Impression: 1. Status post right thyroid cancer surgery with residual thyroid tissue; 2. Presence of left thyroid tissue. Report date: August 21 of the following year

Imaging Report Department: Nuclear Medicine Outpatient Examination time: August 22 of the following year Clinical diagnosis: Post-thyroid cancer surgery Examination: Non-contrast chest CT Technique: Scan from lung apices to bases, 5 mm slice thickness Findings: Tiny nodule in the right upper lobe, linear opacity in the left lower lobe. Possible bilateral pleural thickening with small effusions. Normal hila. Tracheobronchial tree normal. No enlarged mediastinal lymph nodes. Mildly enlarged right axillary lymph nodes. Impression: Tiny nodule in right upper lobe, linear opacity in left lower lobe, possible bilateral pleural thickening with small effusions, mildly enlarged right axillary lymph nodes. Recommendation: clinical correlation and follow-up. Report time: August 22 of the following year

Four years earlier the patient had undergone surgery for thyroid cancer. After the operation she developed generalized discomfort, prominent nighttime pain that prevented sleep, and marked limitation of upper body movements, particularly in the shoulder and neck. These problems persisted, seriously disrupting family life. Over the following years she continued follow-up visits at the same hospital where the thyroid cancer surgery had been performed. She believed her main problem was that the cancer had not been completely removed.