Tracheal collapse as acute presentation in metastatic thyroi
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A 12-year-old boy presented to the emergency department with respiratory distress, cyanosis, and blood oxygen saturation of 80%. No fever or respiratory symptoms were observed, but his parents reported a recent episode of mild exertional dyspnea. Thoracic auscultation revealed fine crackles bilaterally.

Chest radiography showed bilateral multiple diffuse lung microopacities and narrowing of the proximal trachea. Neck and chest computed tomography confirmed the radiography finding and showed a thyroid mass compressing approximately 50% of the tracheal lumen, with a slit-like elliptical shape. USG further confirmed an increased volume and uneven echostructure of the thyroid, with relevant tracheal compression Serum T3, T4, and thyroid stimulating hormone levels were normal, whereas thyroglobulin level was 994 ng/ml (reference value < 77 ng/ml). Total thyroidectomy was performed, which allowed a histological diagnosis of papillary thyroid carcinoma. Thyroid cancer is rare in children, which accounts for 3% of all childhood cancers. Clinical presentation is usually a thyroid nodule; however, papillary carcinoma frequently presents as cervical adenopathy without a palpable thyroid lesion or as an incidental finding after imaging or surgery for unrelated conditions.

Hematogenous metastases to the lungs occur in up to 25% of the cases and are more frequently detected at presentation in children than in adults. Occasionally, lung metastases may have a miliary distribution, with a pattern similar to tuberculosis or other metastatic malignancies, such as melanoma or renal carcinoma. Nevertheless, children with lung involvement are less likely to die from the disease than are adults, and up to 45% develop stable disease following radioactive iodine therapy.

Severe airway obstruction secondary to compression is not rare in children with anterior mediastinal masses and is more frequent with lymphomas. Such presentation is very uncommon in thyroid masses, and only anecdotal reports are available.