Giant adenomatous thyroid nodule compressing the trachea.

This paper details the clinical history and management of a 20-year-old male patient who presented with a 2-year history of a neck swelling which was gradually enlarging during the last 3 months. The tumor was histologically diagnosed as an adenomatous nodule of the thyroid gland.

A 20‐year‐old Japanese man presented to our hospital with a 2‐year history of a neck swelling which was gradually enlarging during the last 3 months. He denied dysphagia, dysarthria, dyspnea, or neck pain. Physical examination revealed a large painless nodule in the right side of the neck (Figure 1A). Laboratory studies, including thyroid function tests, yielded normal findings. Enhanced computed tomography revealed a tumor in the right thyroid lobe, measuring 13 cm by 9 cm, with resultant left laryngeal and tracheal deviation (Figure 1B,C). Considering the size of the tumor and the suspicion of airway obstruction, thyroidectomy was performed. Histology of the specimen confirmed the diagnosis of adenomatous nodule of the thyroid gland. The patient was discharged 10 days after surgery without any complication.

Figure 1

Physical examination revealed a large painless nodule in the right side of the neck (A). Enhanced computed tomography revealed a tumor in the right thyroid lobe, measuring 13 cm by 9 cm, and left tracheal and laryngeal deviation (arrows) and the narrowing of esophagus (arrowheads) due to the tumor in the coronal image (B), and in the sagittal image (C)

Adenomatous nodules are common benign tumors of the thyroid gland. Compared to malignant goiters that grow rapidly and more commonly present as hoarseness or dyspnea, benign goiters enlarge slowly and might be asymptomatic until they become huge.1 These features of benign goiters may lead to delays in seeking medical attention, as seen in our case. The size of a goiter is especially important because large tumors increase the risk of compression of vital structures in the neck, especially the airway, which may lead to a variety of respiratory problems such as respiratory distress, tracheal compression, suffocation, and difficult intubation.1, 2 Clinicians should also be aware of the importance of neck examination because these benign tumors enlarge slowly and may remain asymptomatic.

CONFLICT OF INTEREST

The authors have stated explicitly that there are no conflicts of interest in connection with this article.