A MULTIDISCIPLINARY APPROACH IN MANAGING THYROID ARTERIOVENOUS MALFORMATION WITH THYMOMA

Abstract

Head and neck arteriovenous malformations (AVMs) are rare lesions. They are mostly congenital and tend to progress with age. Despite being rare, they can lead to significant morbidity and mortality. We highlight the case of a 23-year-old lady diagnosed preoperatively with thyroid AVM following unsuspecting symptoms through multidisciplinary team approach. A 23-year-old lady initially presented with hemoptysis, anterior neck swelling and obstructive symptoms. She was investigated for tuberculosis and autoimmune thyroid disorders, but all tests came back negative. Thymoma workup came back positive and she was planned for surgery under the cardiothoracic team. Clinically we noted bruits over goiter. CT Angiogram of neck showed arteriovenous malformation from left superior thyroid artery to inferior thyroid artery. Embolectomy was performed under interventional radiologist over left thyroid AVM then proceeded with total thyroidectomy. Thymectomy was performed by the cardiothoracic team recently, which was uneventful. Arteriovenous malformations (AVMs) are high-flow lesions which involve abnormal fistulous connections between arteries and veins without intervening capillary segments. They are more common in head and neck, with intracranial being most common. Schobinger clinical staging system is used to characterize AV malformations. This patient is classified as Stage 2. Despite successful angioembolization, intraoperatively we found a highly vascularized area surrounding bilateral thyroid glands, estimated blood loss amounted to 2L, requiring blood transfusion intraoperatively. This case emphasizes the importance of multidisciplinary team involvement between endocrinologist, interventional radiologist, vascular surgeon, head and neck surgeon, endocrine surgeon & pathologist in determining the diagnosis and preparing the patient for operation.