title: Myasthenic Crisis Manifesting as Postoperative Respiratory Failure following Resection of Unsuspected Intrathoracic Thymic T-Cell Lymphoma during Thyroidectomy for an Adjacent Large Retrosternal Goiter.
abstract: A middle-aged female with a goiter of 10 years' duration presented with progressive pressure symptoms, nocturnal choking and dyspnea on exertion for 5 months. Physical examination demonstrated a large simple multinodular goiter. Imaging revealed a deep retrosternal goiter extending below the tracheal bifurcation with marked tracheal deviation. Total thyroidectomy was carried out via a cervical approach and a median sternotomy. Extubation was not possible, and the patient had to be kept intubated. She then went into a myasthenic crisis. Initial ventilatory support was followed by intravenous immunoglobulin, steroids and pyridostigmine. The patient had complete remission and was asymptomatic 18 months later. Histopathology showed a T-cell-rich thymoma in addition to a nodular colloid goiter.
authors.affiliation: Khartoum Teaching Hospital, Khartoum, Sudan ; Department of Medicine, Khartoum, Sudan.
authors.forename: Mohamed E
authors.initials: ME
authors.lastname: Ahmed
authors.affiliation: Khartoum Teaching Hospital, Khartoum, Sudan.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Mahgoub
authors.affiliation: Khartoum Teaching Hospital, Khartoum, Sudan.
authors.forename: Mohamed G
authors.initials: MG
authors.lastname: Alnedar
authors.affiliation: Khartoum Teaching Hospital, Khartoum, Sudan ; Department of Medicine, Khartoum, Sudan.
authors.forename: Seif I
authors.initials: SI
authors.lastname: Mahadi
authors.affiliation: Department of Surgery, Faculty of Medicine, at, Khartoum, Sudan.
authors.forename: Maha
authors.initials: M
authors.lastname: Alzubeir
authors.affiliation: University of Ahfad, Khartoum, Sudan.
authors.forename: Lamyaa A M
authors.initials: LA
authors.lastname: El Hassan
authors.affiliation: Alzaeim Alazhari University, Khartoum, Sudan.
authors.forename: ElWaleed M
authors.initials: EM
authors.lastname: Elamin
authors.affiliation: University of Khartoum, Khartoum, Sudan.
authors.forename: Ahmed Mohammed
authors.initials: AM
authors.lastname: El Hassan
keywords: Goiter; Mediastinal neoplasms; Myasthenia crisis; Substernal goiter; Thymoma