• Jing Zhou, Daxue Li, Qian Xiao, Yuchen Zhuang, Ting Yang, Song Xue, Han Gao, and Xinliang Su.
• Department of Breast and Thyroid Department, Women and Children's Hospital of Chongqing Medical University: Chongqing Health Center for Women and Children, Chongqing, China.
• Medicine (Baltimore). 2024 Nov 8; 103 (45): e40371e40371.

RationaleThis case analysis and literature review aim to identify the causes of bilateral chylothorax following thyroid cancer surgery, a rare yet serious complication.Patient ConcernsWe report 2 East Asian women who developed bilateral chylothorax after undergoing total thyroidectomy with neck lymph node dissection. Both patients presented with dyspnea and significant pleural effusion postoperatively.DiagnosesBoth patients were diagnosed with bilateral chylothorax based on clinical examination and imaging studies, including chest ultrasonography and X-rays.InterventionsIn both cases, conservative management was initially implemented, involving chest tube drainage, total parenteral nutrition, and octreotide therapy. Surgical intervention was considered if conservative measures failed to control the chylous output.OutcomesBoth patients showed gradual improvement with conservative treatment, ultimately resulting in successful resolution of pleural effusion and discharge from the hospital without complications.LessonsFor patients with bilateral chylothorax, conservative treatment should be the initial approach for small effusions. For moderate to large effusions, placement of a chest drainage tube is recommended, and surgical intervention should be considered if chyle volume exceeds 10 mL/(kg/d) for 48 to 72 hours or persists for more than 11 days following conservative treatment.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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