89yo female total thyroidectomy for large goitre. Symptoms of SOB, dysphagia and orthopnoea.

Background

• HTN
• AF – no embolic events
• T2DM – HbA1c 7.8%. Occasional hypoglycaemia
• CFS – 5
• RA – no neck involvement
• CKD – eGFR 35
• Low ET: DASI 3.9METs
• Recent COVID infection in May

Issues

• ? Appropriateness for surgery

Discussion

• ? Requires further investigations for SOBOE – does the history fit with goitre as the cause of the symptoms
• High risk surgery, but patient is aware of risks and feels the symptoms from goitre are affecting her QoL
• Awaiting ACD planning

Plan

• Advanced care planning
• Consideration of TTE and further investigation for SOBOE to exclude causes separate to the goitre.