A 67-year-old male patient was investigated for nonproductive cough associated with dyspnea and recent dysphagia for solid foods. Clinical examination revealed tracheal deviation to the right side. Chest roentgenogram demonstrated an eggshell calcificated mass to the left of the midline in the upper mediastinum pushing the trachea rightward (Figure ). Computed tomography (CT) scan with intravenous contrast demonstrated an extensive mass surrounded by a calcification downside of the left lobe of the thyroid gland with extension to the upper mediastinum and significant tracheal deviation to the right (Figure ). The mass was 53 × 53 × 80 mm in size. Angio-CT demonstrated that no communicated vessel with the mass. Tc-99m pertechnetate thyroid scan demonstrated a mass at the bottom of the left lobe in the thyroid gland with low uptake (0.1%, normal range: 0.5% to 3.50%) corresponding to the radiological demonstrated mass (Figure ). Because of low uptake in thyroid scan, it was reported as thyroiditis.
Chest roentgenogram demonstration of an eggshell calcificated mass.
CT scan demonstration of a calcificated mass downside of the left lobe of the thyroid gland.
Tc-99m pertechnetate thyroid scan demonstrated a mass at the bottom of the left lobe in the thyroid gland with low uptake.
In his previous medical history, he had cerebral hemorrhagic stroke in year 2000. His physician prescribed acetylsalicylic acid 100 mg (Coraspin 100 mg, Bayer). After a gastrointestinal bleeding, he left using acetylsalicylic acid with his physician recommendation. But he was not aware of an acute swelling in thyroid region and acute respiratory distress at the gastrointestinal bleeding term.
The WBC was 8300/L (normal, 3500–9700); hemoglobin was 12.0 g/dL (normal, 11.2–15.2); platelet count was 241 × 103 K/uL (normal, 142 – 424 × 103). Prothrombin time and partial thromboplastin time were 84% (normal, 80 – 120) and 26.9 second (normal, 26.0 – 38.0), respectively. Thyroid profile results demonstrated TSH of 1,25 μIU/mL (normal, 0.4 – 4.0); free T3, 2.18 pg/mL (normal, 1.8 – 4.3); free T4, 0.975 ng/mL (normal, 0.2 – 1.9); thyroglobulin in blood, 24 ng/mL (normal, 0 – 55).
He was taken to surgery for thyroid exploration. The operative findings were that the left lobe of thyroid gland was swollen, tense, and calcificated, expanding to the superior mediastinum, whereas the right lobe was normal. Left lobectomy was successfully performed with sternotomy (Figure ). On gross examination, the cut surface of resected lobe revealed a distinct yellow- brown muddy content, 8 cm in greatest diameter, located in the whole of the left thyroid gland (Figure ). A rim of the calcification in the periphery was apparent (Figure ). The pathological examination revealed eggshell calcification of the thyroid gland with old massive intrathyroidal bleeding. He recovered uneventfully. He was discharged in good condition on the 3rd postoperative day. Three months after the operation, the thyroid function was normal.
The cut surface of resected lobe revealed a distinct yellow- brown muddy content.
The calcification in the periphery.