A 40-year-old woman with a history of anxiety-depressive syndrome and hepatitis A in childhood was referred to our service due to increased thyroid size and laterocervical lymphadenopathy.
Needle aspiration biopsy revealed an adenopathy due to papillary thyroid carcinoma and was referred to the Surgery Department for treatment.
She underwent total thyroidectomy with bilateral functional cervical fixation (levels II, III, IV and V) and the central compartment of the neck.
Both recurrent nerves were preserved, the two inferior parathyroids were reimplanted and the thoracic duct was ligated.
The immediate postoperative complication was transient hypocalcemia.
She was discharged 5 days after the intervention.
The result of the pathological anatomy confirmed the existence of a multifocal papillary carcinoma with lymph node metastases in both cervical and recurrent chain regions.
Ten days after surgery, the patient suddenly presented swelling in the left cervical region with posterior evolution to the anterior and right cervical regions.
There were no inflammatory signs.
The patient was evaluated by the Aspiration Surgery Service to place a low pressure drainage catheter when a thoracic duct fistula was suspected.
The discharge of fluid with a digestive appearance and a concentration of triglycerides 1410 mg/dl confirmed the clinical suspicion, being our consultations for dietary treatment.
1.
In the consultation a basic anthropometric and analytical assessment was performed, aiming that the patient was normonourished and without metabolic complications arising from the fistula.
The prescription and education of the patient of a low diet in TCL was initiated.
Written dietary instructions (Table I) were given and supplemented with MCT oil at a dose of 40 cc/day.
Between analytical and anthropometry before dietary treatment and those performed two weeks later there were no significant differences without objectifying metabolic complications characteristic of this pathology.
Before starting the dietary treatment, the patient had a maximum daily drainage of 400 cc of lymph.
On the second day of treatment, the fluid obtained by drainage decreased to 100-200 cc daily and its macroscopic characteristics varied, becoming clearer, with a more serous and less chylous appearance.
The dietetic treatment and percutaneous drainage were maintained until day 14 after which, when minimal fluid outflow was observed and no chylous characteristics were removed percutaneous access.
The dietetic treatment was maintained for 4 more days to observe the evolution after the removal of the drainage and in the absence of signs suggesting recurrence the diet was liberalized, finding the patient currently asymptomatic and with free diet.
