Delayed respiratory distress after thyroidectomy—another challenge for us: a case report

BACKGROUND: Delayed airway obstruction and the resulting severe dyspnea with acute distress are rare but life-threatening postoperative thyroidectomy complications. Unfortunately, if not adequately attended to on time, they could cost a patient’s life. CASE DESCRIPTION: A 47-year-old female patient who underwent thyroidectomy was left at the end of surgery with a tracheostomy, because of tracheomalacia and recurrent laryngeal nerve injury. Within the next ten days, her health condition gradually worsened. She complained of unexpected symptoms of shortness of breath, airway compromize and neck inflammation even with the existing tracheostomy tube. In face of new onset dyspnea, without giving proper attention to the postoperative course of this complicated patient, the consulting otorhinolaryngologist decided to decannulate the patient on the sixth postoperative day. This precipitated the presentation of an extensive neck infection with resultant total bilateral vocal fold immobility, followed by life-threatening airway obstruction, due to an unintentionally forgotten gauze in peritracheal space during thyroidectomy. In critical condition, the patient was successfully intubated with Rapid Sequence Induction, which enabled ventilation, oxygenation and saved the patient’s life. After definitively securing the airway, she underwent tracheostomy with tracheal re-cannulation. After a prolonged antimicrobial course and achieving voice rehabilitation, the patient was decannulated. CONCLUSIONS: Post thyroidectomy dyspnea is possible even with tracheostomy in place. The decision-making in the management of a thyroidectomy patient is of paramount importance not only intraoperatively, but also in the postoperative period and the gland surgeon expertise is of supreme value for avoiding life-threatening complications. In case of postoperative complaints, the patient should be referred first to the gland surgeon and only thereafter to other medical consultants. Disregarding a variety of factors like patient characteristics, risk factors and comorbidity, available diagnostic tools and specific recovery profile could cost the patient’s life.