Thyroidectomy and chronic dyspnoea

67-year-old lady for left hemithyroidectomy


  • Moderate COPD. Can walk 100m on flat. Ceased smoking 10 years ago.
  • OSA –Compliant with CPAP
  • BMI 41
  • Bipolar Affective Disorder – severe anxiety. Lives alone. Brother is enduring guardian
  • Multinodular Goitre for many years. Euthyroid.


  • Surgical letter states worsening dyspnoea. Uncertain if due to goitre.  Some tracheal deviation but no retrosternal extension
  • Chronic dyspnoea. Documented over many years by respiratory physician
  • Extensive investigations:  Spiro and DLCO around 50% of predicted

  Cardiac investigations including stress echo NAD

  • Difficult to gain accurate history over phone. Patient not answering phone.
  • Distance patient. No transport options
  • Brother lives far away but calls her every night
  • Discussed with brother – doesn’t feel she is any worse. SOB for many years
  • Independent with ADLs. Shops and cooks for herself.
  • GP declined to share medical information
  • Referred back to respiratory physician; “better than she was 10 years ago.’ unsure why she needs a thyroidectomy.
  • Discussion with surgeon who liaised with respiratory physician and GP. Decision to cancel as procedure not required.


Phone consultation in Distance patients

  • Clinical assessment can be very challenging in these circumstances.
  • Surgeon seems to have had the same difficulties with telehealth
  • How can we best assess distance patients? Face to face appointments would be the best way to assess but not always possible.
  • Can we videocall vs ask GP for clinical assessment – again would require significant set-up
  • Asking a local physician who knew the patient well turned out to be an ideal solution in this situation.