Untreated Hyperthyroidism and a Mediastinal Mass: To Remove or Not To Remove?

Abstract

CASE PRESENTATION: J.W. was seen by the PACE (Preoperative Assessment, Communication and Education) Center prior to a mediastinal mass resection. Medical history includes well-controlled rheumatoid arthritis, anxiety and a recent diagnosis of hyperthyroidism. Labs were significant for TSH DISCUSSION: Untreated GD is rarely correlated with thymic hyperplasia; however the pathogenesis is not well understood. Regardless of the association, contextualization of this patient\u27s history and lab values prompted the provider to seek specialized management. This finding was then communicated with the surgical team, who often rely on PACE providers to screen patients with the ultimate goal of risk reduction and optimization of clinical outcomes. Unfortunately, there is minimal literature documenting evidence of patients who are poorly optimized prior to surgery. CONCLUSIONS: Preoperative screening from a provider with high clinical acumen and a high index of suspicion resulted in appropriate referral and timely intervention for this patient with an unoptimized comorbidity. An appointment with PACE prevented this patient from undergoing surgery and developing a life threatening complication (Thyroid Storm) from an elective procedure. Despite a recent shift against preoperative screening, this case report highlights the importance of a comprehensive evaluation and multidisciplinary approach ensuring appropriate standard of care and patient safety