The Hidden Goiter
In November 2020, Johneshia Willis contracted COVID-19 and was hospitalized in intensive care for nearly two months. When her care team was unable to extubate her, Douglas Stanley, MD, an assistant professor in the Department of Otorhinolaryngology at McGovern Medical School at UTHealth Houston, performed an elective tracheostomy. She was transferred to long-term care at Kindred Hospital, where clinicians removed the tracheostomy tube before her discharge in January 2021.
Over time, Willis noticed she had shortness of breath and wheezing. “My wheezing was out of control, and my mother could hear me snoring at night,” she says. “I had never had problems with snoring before.”
Four months after her discharge from care for COVID-19, she saw Ibrahim “Trey” Alava III, MD, an associate professor in the department and chief of otolaryngology-head and neck surgery at Lyndon B. Johnson Hospital, part of Harris Health System, where he also serves as medical director of the hospital’s 32 specialty clinics. After an in-office endoscopic examination revealed tracheal stenosis, he took her to the OR for minor surgery to open her airway.
When Willis returned for her postoperative follow-up, Dr. Alava suspected that another problem was causing airway compression and ordered a CT scan. The imaging study revealed a large left-side thyroid goiter near the collarbone and behind the sternum, compressing her trachea.
“The goiter was not readily visible because it was low in the neck and also because of Ms. Willis’ anatomy. She has a shorter-than-usual neck due to Turner syndrome,” he says.
Willis was diagnosed with the genetic disorder at the age of 18, when her mother became concerned because she was not menstruating. The most common feature of Turner syndrome is short stature; Willis is 4’8” tall. In women diagnosed with the disorder, one copy of the X chromosome is missing or altered, and reduced functioning of the ovaries and female sex hormones is common.
“When my family practitioner listened to my symptoms, she knew immediately and referred me to an endocrinologist to confirm the diagnosis,” she says. “Technically, I’m in early menopause at age 34.”
Dr. Alava removed the goiter and dilated her trachea in 2021, nearly two years ago. “My breathing has been fine since then and I have no wheezing,” she says. “I absolutely love Dr. Alava. I do have issues during the winter and get very bad colds. If I need anything, I text him and he makes himself available.”