Virginia Via Research Day Book 2026

Medical Student Research Case Reports

14 INCIDENTAL DISCOVERY OF THYRO-TRACHEAL FISTULA DURING ELECTIVE THYROIDECTOMY: A CASE REPORT

Hannah Duraiswamy, OMS III; Amber Miller, OMS III; Jeffrey Sinclair, MD Corresponding author:hduraiswamy@vcom.edu

VCOM-Virginia, Blacksburg, Virginia

identified. A 3–4 mm tracheal defect was repaired primarily and reinforced with a pedicled strap muscle flap. The thyroid was fully resected with preservation of both recurrent laryngeal nerves. The patient had an uncomplicated postoperative course and was discharged the following day on oral antibiotics. At follow-up, she demonstrated good wound healing, stable voice, and no dysphagia or hypocalcemia. Methods: A literature review was conducted using NCBI, PubMed, and Google Scholar with the terms “thyroid abscess,” “thyrotracheal fistula,” “pyriform sinus fistula,” and “multinodular goiter.” Fistula formation may occur as a result of congenital developmental abnormalities, infection, inflammation, or iatrogenic injury. In this case, the thyroid isthmus– trachea fistula was most likely caused by inflammatory extension from a thyroid abscess, leading to erosion into the adjacent tracheal wall. Unlike most reported thyro-tracheal fistulas, which are associated with malignancy or congenital pyriform sinus tracts, this

patient had a benign multinodular goiter and no laboratory abnormalities or systemic or local signs of thyroid infection or dysfunction aside from compressive symptoms. This case demonstrates that clinically silent thyroid abscesses can still result in destructive complications, including fistula formation, even in immunocompetent patients with otherwise benign disease. Diagnosis: Benign thyroid isthmus–trachea fistula secondary to occult thyroid abscess in a multinodular goiter certainty: high, based on intraoperative visualization. Consent: The authors obtained consent from the patient to use their data for this case report.

Context: Thyrotracheal fistulas are rare and are typically associated with congenital pyriform sinus anomalies, invasive thyroid malignancy, or severe infection. Benign fistulas involving the thyroid isthmus are exceptionally uncommon, particularly when discovered incidentally during surgery for a multinodular goiter without prior infectious symptoms. Report of Case : A 70-year-old female with a six-year history of multinodular goiter presented for elective total thyroidectomy due to compressive symptoms, including dysphagia to solids and discomfort while lying supine. She denied fever, neck pain, voice changes, or signs of infection. Preoperative ultrasound demonstrated a stable multinodular goiter, and prior fine-needle aspiration biopsies were reportedly benign. Thyroid function tests were consistent with subclinical hyperthyroidism. During mobilization of the thyroid isthmus intraoperatively, purulent fluid was encountered, and a previously unrecognized fistulous tract between the thyroid isthmus and trachea was

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