Obstructive sleep apnea (OSA) may be linked to various factors that narrow the upper airways, such as obesity, adenotonsillar hypertrophy and craniofacial abnormalities. Hypothyroidism has also been described as a risk factor for OSA. However, the implication of goiter independently of thyroid function in the occurrence of OSA remains unclear. We present the case of a 66-year-old patient, with a large compressive multinodular goiter for whom total thyroidectomy was indicated. During the preoperative assessment, the patient showed a body mass index (BMI) of 37.8 kg/m2 with symptoms of OSA. Respiratory polygraphy confirmed the diagnosis of severe OSA (apnea hypopnea index: AHI=32) and treatment with continuous positive airway pressure (CPAP) was initiated prior to thyroid surgery. Surprisingly, after total thyroidectomy, OSA symptoms disappeared and the patient abandoned CPAP therapy. Subsequent respiratory polygraphy after thyroidectomy showed a decrease in AHI to a normal value (AHI < 5). Interestingly, there was no change in BMI or other factors explaining the resolution of OSA, except for thyroidectomy. This case report suggests that goiter can be considered a risk factor for OSA. However, prospective studies are needed to accurately assess the effects of goiter on occurrence of OSA according to its dimensions and local extension.

Obstructive sleep apnea (OSA) may be linked to various factors that narrow the upper airways, such as obesity, adenotonsillar hypertrophy and craniofacial abnormalities. Hypothyroidism has also been described as a risk factor for OSA. However, the implication of goiter independently of thyroid function in the occurrence of OSA remains unclear. We present the case of a 66-year-old woman with a large compressive multinodular goiter for whom total thyroidectomy was indicated. During the preoperative assessment, the patient had a body mass index (BMI) of 37.8 kg/m² with symptoms of OSA. Respiratory polygraphy confirmed the diagnosis of severe OSA (apnea–hypopnea index (AHI) = 32), and treatment with continuous positive airway pressure (CPAP) was initiated prior to thyroid surgery. Surprisingly, after total thyroidectomy, OSA symptoms disappeared, and the patient abandoned CPAP therapy. Subsequent respiratory polygraphy after thyroidectomy showed a decrease in AHI to a normal value (AHI < 5). Interestingly, there was no change in BMI or other factors explaining the resolution of OSA, except for thyroidectomy. This case report suggests that goiter can be considered a risk factor for OSA. However, prospective studies are needed to accurately assess the effects of goiter on the occurrence of OSA according to its dimensions and local extension.

Aim: To assess correlation between fibrosis severity and bronchoalveolar lavage (BAL) profile in interstitial lung disease (ILD). Methods: A retrospective study was conducted including 111 patients with confirmed diagnosis of ILD by HRCT. Semi-quantitative scale as proposed by Warrick was used. Total score (TS), indices for alveolitis (AI) and fibrosis (FI) were assessed. According to the total score, fibrosis was classified as mild (15. BAL was performed in 82% of cases. Results: Mean age was 59.3 years. Sex ratio was 0.76. Main etiologies were idiopathic ILD (38.7%), sarcoidosis (28.8%) and connectivite tissue diseases (13.5%). Most frequent Warrick elementary lesions were septal and no septal lines (77.5%) and ground glass opacities (48.6%). TS, AI and FI were 1.67±1.73; 9 ± 5.8 and 10.2 ±6.3 respectively. Fibrosis was mild (31.5%), moderate (51.4%) and severe (17.1%). Patients with mild fibrosis had greater BAL lymphocyte counts and CD4/CD8 ratio (p=0.043 and 0.031) and lower eosinophil rates (p=0.04). There were no correlations between BAL profiles and AI. Whereas significant correlations were found between TS and FI and lymphocyte (p=0.001; r=-0.33 and p<0.001; r=-0.38) and neutrophil (p=0.021; r=0.24) rates. TS correlated inversely with CD4/CD8 ratio (p=0.04; r=-0.29). Septal and no septal lines and honeycombing lesions were associated with lower lymphocyte (p=0.02 and p<0.001) and higher neutrophil (p=0.001 and p=0.032) and eosinophil (p=0.007 and p=0.09) counts. Conclusion: Fibrosis extent and severity in ILD correlate with neutrophil rates and inversely with lymphocyte counts in BAL.