Huge 970 gm thyroid gland removed from 45-year-old woman's neck

The 45-year old had approached Jehangir hospital and in the last week of April, she was operated and the gland was removed successfully. She had a Type 3 Tracheomalacia which made her surgery quite risky

There is phrase 'a stitch in time saves nine'. When it comes to health one must always take caution. A Pune-based 45-year-old housewife named Jui Poonawala (name change to protect the identity) who had complained about swelling in her neck due to Thyroid enlargement neglected it despite the doctor's advice to remove such gland. Two decades later, the gland grew as big as a watermelon, although an operation was conducted and the gland was successfully removed.

The 45-year old had approached Jehangir hospital and in the last week of April, she was operated and the gland was removed successfully. She had a Type 3 Tracheomalacia which made her surgery quite risky.

Poonawala, in the past, had approached the doctor who told her that it was due to a Thyroid enlargement called a 'Goitre'. She was advised surgical removal of the gland but being apprehensive of the surgery, she did not pay heed to it. Over the years, it slowly and steadily went on increasing and after 20 years, it nearly approached the size of a watermelon.

It appeared strange and to avoid public attention during social meetings she started covering it with her dupatta. However, over a period of time, she realized that sooner or later she would have to get rid of the lump in the neck. Poonawala was adviced by Endocrinologist Dr Shreerang Godbole and later to Dr Pradeep Sharma, a Senior surgeon at Jehangir Hospital who specializes in General, GI and Endocrine surgery. She was prepared for the surgery as it was quite delicate due to its very nature as well as the sheer size of the gland.

Poonawala was counselled and prepared for the surgery. Giving anaesthesia to such a patient is a challenge as sheer pressure of such a large gland in front of the windpipe makes placing the anaesthesia tube difficult. This challenge was taken up by Dr Pratibha Kane, Dr Sameer Bhosale and the Jehangir anaesthesia team.

During Surgery, Dr Pradeep Sharma and his team removed the gland without disturbing the nerves and Parathyroid gland. Post removal, the gland weighed 970 gm amongst one of the largest glands. The thyroid gland is a very vascular gland and sometimes it leads to a lot of blood loss. In this case, however, due to Capsular dissection technique and modern instrumentation, she did not have any unusual blood loss.

She was nursed to the ICU wherein she was looked after by Dr Kayanoosh Kadaptti and the ICU team. She was on the Ventilator to allow the windpipe to recover its strength. She recovered well after removing the tube and able to get back to her home in a weeks time without a Tracheostomy. She is doing well post surgery after being put on HRT Hormone replacement therapy.

Dr. Pradeep Sharma, Jehangir Hospital said, "Sometimes Tracheomalacia demands to make a hole in the windpipe and put a plastic tube for some days (Tracheostomy). Thyroid surgery also carry a chance of change in voice as the nerves going to the voice box (Larynx) are in close proximity to the thyroid gland. There are 4 small glands called Parathyroid glands situated behind the Thyroid which control the Calcium levels in the body and hence need to be preserved. All this makes Thyroid Surgery a very delicate surgery especially in a situation as this case, i.e. a very large Goitre wherein the anatomy is disturbed and structures deviate from their normal positions."

Thyroid Gland is an hormone-producing gland situated in front of the neck over the windpipe and produces thyroid hormones (T3 & T4) which are responsible for the metabolism of the body. When the hormone levels are high, they increase the metabolism of the body and cause weight loss along with many effects of the body (Hyperthyroidism). When the hormone levels reduce, they slow the metabolism of the body and cause weight gain in addition to other deleterious effects on the body systems (Hypothyroidism). When the gland size increases it causes a condition called as 'Goitre'.

Iodine deficiency goitres are now rarely seen as most of us consume iodized salt in our diet. Other causes of goitre are Familial and Hereditary deficiency of enzymes responsible for hormone manufacturing, Autoimmune conditions, infections, radiations and occasionally cancers.

A problem seen with long-standing goitres is softening of the windpipe due to pressure (Tracheolamacia) which can result in choking before or after surgery. Thyroid surgery also carries a chance of change in voice as the nerves going to the voice box (Larynx) are in close proximity to the thyroid gland. There are 4 small glands called Parathyroid glands situated behind the Thyroid which control the calcium levels in the body and hence need to be preserved. All this makes Thyroid Surgery a very delicate surgery especially in a situation as this case, i.e. a very large Goitre wherein the anatomy is disturbed and structures deviate from their normal positions.

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