Abstract Introduction Spontaneous pneumothorax (SP) is an emergency condition characterized by the accumulation of air within the pleural cavity without any preceding mechanical trauma or iatrogenic cause. The occurrence of SP in patients with thyroid neoplasms and thyrotoxicosis is extremely rare. Although follicular thyroid neoplasms have been reported to present with hyperthyroidism due to functioning primary tumors or metastatic lesions, the association with acute pulmonary complications such as spontaneous pneumothorax has not been well documented in recent literature. Case Report A 30-year-old man presented with a sudden onset of severe dyspnea and right-sided chest pain. His medical history was notable for a goiter, for which he had declined further evaluation or treatment. He reported significant weight loss despite an increased appetite, along with heat intolerance, excessive sweating, tremor, and palpitations. Physical examination revealed a diffuse, firm mass in the anterior neck. Chest examination showed hyperresonance and diminished vesicular breath sounds on the right side. Thyroid function tests demonstrated elevated total T4 (15.52 µg/dL), free T4 (5.00 ng/dL), and suppressed TSH (0.005 µIU/mL). Fine-needle aspiration biopsy (FNAB) of the thyroid suggested a follicular neoplasm. Chest radiography revealed an avascular radiolucent area in the right lung. Following insertion of a water-seal drainage (WSD), chest computed tomography (CT) demonstrated subcutaneous emphysema, a right pneumothorax with compressive atelectasis of the right lung, pneumomediastinum, and a minimal right pleural effusion. Discussion This case represents an unusual occurrence of spontaneous pneumothorax in a setting of thyrotoxicosis caused by follicular thyroid neoplasm. Although hyperthyroidism is known to induce a hypermetabolic state that increases oxygen demand and ventilatory drive, its direct association with pneumothorax remains unclear. Previous reports of pneumothorax in association with thyroid neoplasms have predominantly involved pulmonary metastases or treatment-related complications. Further guidelines are needed to better understand the pathophysiology and to establish optimal management for better outcomes. This abstract is funded by: None
Jito et al. (Fri,) studied this question.
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