We report a case of chronic thyroiditis with upper airway obstruction associated with myxedema.
The patient, a 68-year-old man, presented to our emergency room on Saturday evening with complaints of dysarthria and wheezing since the same morning. After securing the airway with a nasal airway, the patient was referred to the on-call otolaryngologist.
CT showed no obvious abscess. The patient had marked edema and stenosis at the oral and middle pharyngeal levels and redness and swelling of the face, suggestive of infection or angiogenic edema.
Prophylactic tracheostomy was recommended because of the anticipated difficulty in intubation, but the patient refused consent. Therefore, we treated the patient with a steroid and antibiotics and decided to observe the patient with a nasal airway in place. In the middle of the night, the patient’s respiratory condition worsened and an emergency tracheostomy was performed.
Subsequently, clinical examination and further work-up revealed extreme hypothyroidism and chronic thyroiditis were found, and the upper airway obstruction was thought to be caused by myxedema. The neck swelling improved after administration of thyroid hormones, and the tracheostomy was closed.
Hypothyroidism with myxedema is known to be associated with obesity and hypoventilation. In severe cases, respiratory failure with hypercarbia may occur. In this case, in addition to respiratory failure, the upper airway obstruction may also led to the need for securing the airway.
