Thursday, August 22, 2013


     As a lung specialist I often see patients with the complains of shortness of the breath . I have mentioned  many common causes of the shortness of the breath . I saw a patient recently saw a patient which had one more not very common cause .
     I saw this 67 years old female , who was referred to me by a cardiologist . She had shortness of the breath and some difficulty swallowing . She was seen by her primary care physician and had X -ray done . She had history of high blood pressure and was little obese . She also had hypothyroidism , low function thyroid , which I see in may be 30-40 % of the females that I see . She was referred to a cardiologist and he did the work up . She had echocardiogram , and a stress test and both were normal . The cardiac cause for the shortness of the breath was ruled out . So with her other complaints , he decided to referred to me and a gastroenterologist . So I saw her . There was not much in her history . I was sure that her lung would be 'clear ' as if there were some findings , they would have been picked up by these 2 physician . So I was thinking about doing the breathing  tests and some other work up .I had not examined her yet .
    So when I started examining her . I put my hand on her neck . I normally check for the lymph nodes and the thyroid . I was surprised . I felt a  Hugh thyroid , some what firm . It was extending way out of it's normal position . I knew why she was short of breath and may be why she had some difficulty swallowing . I asked her if she knew about her thyroid . She told me that she had a condition called Hashimoto's thyroiditis . This is a condition where patients get inflammation of thyroid and it enlarges . It may be tender . This is a condition , where there are antibodies against the thyroid and then they attack the thyroid and then over period of time , patient gets low functioning thyroid as the thyroid is damaged . So the history of low functioning thyroid was true , but the cause for it was not common . When thyroid has this problem and then it is under functioning , it becomes big . In case of this patient it was HUGH . I told her about her about my diagnosis . I was worried about the enlarged thyroid pressing on the trachea , the wind pipe and causing the shortness of the breath .I ordered the CT scan of the neck and the chest , as I was worried that the enlarged thyroid might be inside the chest . I got the CT scan reports . Both the suspicions were correct . There was big thyroid and it had deviated the trachea and it was so big that it was extending to the chest .
    I called a thyroid surgeon for the surgery .This is one of these unusual causes of the shortness of the breath where there is a mechanical cause out side the lungs and lungs themselves are OK .

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