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Unusual Life-Threatening Complication of a Substernal Goiter: A Case of an Upper Gastrointestinal Bleed
Substernal goiter represents a common and challenging clinical scenario in medical practice. Symptoms often include dysphagia, dyspnea, and hoarseness, deeming the vascular compressive symptoms an unusual finding. In extraordinarily rare cases, its slow and gradual growth determines the emergence of...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9988437/ https://www.ncbi.nlm.nih.gov/pubmed/36895534 http://dx.doi.org/10.7759/cureus.34633 |
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author | Guia Lopes, Maria Leonor O'neill, Catarina Antunes, Carolina Limbert, Clotilde Sequeira Duarte, João |
author_facet | Guia Lopes, Maria Leonor O'neill, Catarina Antunes, Carolina Limbert, Clotilde Sequeira Duarte, João |
author_sort | Guia Lopes, Maria Leonor |
collection | PubMed |
description | Substernal goiter represents a common and challenging clinical scenario in medical practice. Symptoms often include dysphagia, dyspnea, and hoarseness, deeming the vascular compressive symptoms an unusual finding. In extraordinarily rare cases, its slow and gradual growth determines the emergence of severe superior vena cava syndrome, with consequent development of upper esophageal downhill varices. In contrast with distal esophageal varices, downhill variceal hemorrhage is extremely rare. The authors report a patient admitted to the emergency room due to upper gastrointestinal hemorrhage, caused by downhill upper esophageal varices’ rupture, secondary to compressive substernal goiter. In this case, irregular follow-up resulted in massive thyroid growth, progressive vascular and airway compression, and the development of venous collateral pathways. Despite the severity of those compressive symptoms, the patient was not a surgical candidate considering her multiple cardiovascular and respiratory comorbidities. Newly developed thyroid ablative techniques may emerge as a possible life-saving treatment when the surgical approach cannot be considered. |
format | Online Article Text |
id | pubmed-9988437 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-99884372023-03-08 Unusual Life-Threatening Complication of a Substernal Goiter: A Case of an Upper Gastrointestinal Bleed Guia Lopes, Maria Leonor O'neill, Catarina Antunes, Carolina Limbert, Clotilde Sequeira Duarte, João Cureus Endocrinology/Diabetes/Metabolism Substernal goiter represents a common and challenging clinical scenario in medical practice. Symptoms often include dysphagia, dyspnea, and hoarseness, deeming the vascular compressive symptoms an unusual finding. In extraordinarily rare cases, its slow and gradual growth determines the emergence of severe superior vena cava syndrome, with consequent development of upper esophageal downhill varices. In contrast with distal esophageal varices, downhill variceal hemorrhage is extremely rare. The authors report a patient admitted to the emergency room due to upper gastrointestinal hemorrhage, caused by downhill upper esophageal varices’ rupture, secondary to compressive substernal goiter. In this case, irregular follow-up resulted in massive thyroid growth, progressive vascular and airway compression, and the development of venous collateral pathways. Despite the severity of those compressive symptoms, the patient was not a surgical candidate considering her multiple cardiovascular and respiratory comorbidities. Newly developed thyroid ablative techniques may emerge as a possible life-saving treatment when the surgical approach cannot be considered. Cureus 2023-02-04 /pmc/articles/PMC9988437/ /pubmed/36895534 http://dx.doi.org/10.7759/cureus.34633 Text en Copyright © 2023, Guia Lopes et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Endocrinology/Diabetes/Metabolism Guia Lopes, Maria Leonor O'neill, Catarina Antunes, Carolina Limbert, Clotilde Sequeira Duarte, João Unusual Life-Threatening Complication of a Substernal Goiter: A Case of an Upper Gastrointestinal Bleed |
title | Unusual Life-Threatening Complication of a Substernal Goiter: A Case of an Upper Gastrointestinal Bleed |
title_full | Unusual Life-Threatening Complication of a Substernal Goiter: A Case of an Upper Gastrointestinal Bleed |
title_fullStr | Unusual Life-Threatening Complication of a Substernal Goiter: A Case of an Upper Gastrointestinal Bleed |
title_full_unstemmed | Unusual Life-Threatening Complication of a Substernal Goiter: A Case of an Upper Gastrointestinal Bleed |
title_short | Unusual Life-Threatening Complication of a Substernal Goiter: A Case of an Upper Gastrointestinal Bleed |
title_sort | unusual life-threatening complication of a substernal goiter: a case of an upper gastrointestinal bleed |
topic | Endocrinology/Diabetes/Metabolism |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9988437/ https://www.ncbi.nlm.nih.gov/pubmed/36895534 http://dx.doi.org/10.7759/cureus.34633 |
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