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Jehangir-hospital-pune

A 45-year-old female, Mrs Electricwala, noticed a swelling in the neck. She approached a doctor who told her that it was due to thyroid enlargement and it was known as ‘Goitre.’

She was advised surgical removal of the gland but being apprehensive of 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 realised that sooner or later she would have to get rid of this lump in the neck.

This is when she was referred by her Endocrinologist Dr Shreerang Godbole to Dr Pradeep Sharma, a senior surgeon at Jehangir Hospital who specialises in General, GI and Endocrine surgery. She was prepared for the surgery as the surgery was quite delicate due to its very nature as well as the sheer size of the gland.

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.

Mrs Electricwala had a Type 3 Tracheolamacia which made her surgery risky. Sometimes, this can demand making a hole in the windpipe in the neck and put a plastic tube in for some days (Tracheostomy).

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.

Mrs Electricwala was counselled and prepared for the surgery. Giving anaesthesia to such 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 Mrs Pratibha Kane, Dr Sameer Bhosale and the Jehangir Hospital’s anaesthesia team. During Surgery, Dr Pradeep Sharma and his team removed this large gland without disturbing the nerves and Parathyroid gland.

Post removal, the gland weighed a 970 gm (Nearly 1Kg) amongst one of the largest gland. The thyroid gland is a very vascular gland and sometimes associated with a lot of blood loss. In this case however due to good surgical techniques and modern instrumentation, she did not have any unusual blood loss.

She was nursed in the ICU wherein she was looked after by Dr Kayanoosh Kadaptti and the ICU team. She was kept on the Ventilator to allow the windpipe to recover its strength.

She made a good recovery 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.

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