Chyle leak (CL) secondary to inadvertent thoracic duct injury (TDI) is an exceptionally rare complication of a right hemithyroidectomy. TDI occurs in 0.5-1.4% of patients undergoing a thyroidectomy, and of those, only one-fourth are attained following right-sided neck surgeries, as the terminal thoracic duct (TD) typically terminates in the left side of the neck. Anatomical variations of the terminal TD are well renowned, and a right-sided terminal TD has been previously described. Although CL following right-sided neck dissection has been described in the literature, to our knowledge, this is the third case to describe a CL following a right hemithyroidectomy alone.We present a man in his 70s who was referred to endocrinology with a persistently low T4 on a background of normal Thyroid Stimulating Hormone(TSH). Incidentally, he was found to have a bilateral large goitre associated with chronic dyspnoea and dysphagia. He was planned for a total thyroidectomy; however, due to intraoperative difficulties, he underwent a right hemithyroidectomy only. Four days later, he re-presented with neck swelling and breathlessness. Re-explorative surgery identified serosanguinous fluid which later tested positive for chylomicrons, confirming a CL, likely from a right-sided terminal TD. Generally, he demonstrated a good response to conservative treatment.Complex anatomical variations of the TD exist and thus CL should be well-recognised as a differential diagnosis of neck swelling following both left-sided neck and right-sided neck surgeries. Head and neck surgeons should consider consenting patients undergoing right-sided neck surgeries for a CL.

Keywords: Ear, nose and throat; Ear, nose and throat/otolaryngology; Endocrine system; Endocrinology; Thyroid disease.

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胸导管（TD）意外损伤导致的乳糜漏(CL)是右侧半甲状腺切除术后极其罕见的并发症。在接受甲状腺切除术的患者中，TDI的发生率为0.5-1.4%，而在这些病例中，只有四分之一是在右侧颈部手术后发生的，因为终末胸导管通常终止于左侧颈部。终末TD的解剖变异是众所周知的，并且之前曾描述过右侧终末TD的情况。尽管文献中有报道CL在右侧颈淋巴结清扫术后的发生情况，据我们所知，这是第三例仅在接受右侧半甲状腺切除术后出现CL的病例。我们介绍了一位70多岁的男性患者，因持续性低T4而被转介至内分泌科就诊，同时伴有正常的促甲状腺激素(TSH)水平。在背景检查中意外发现他患有双侧巨大甲状腺肿，并且与慢性呼吸困难和吞咽困难相关。原计划进行全甲状腺切除术；然而由于手术中的困难，最终仅进行了右侧半甲状腺切除术。四天后，患者再次出现颈部肿胀和气短症状。重新探查手术时发现了血清性液体，后来检测出含有乳糜微粒，确认了CL的发生，可能来自右侧终末TD。总体而言，他对于保守治疗有良好的反应。 复杂的TD解剖变异确实存在，因此，在左侧或右侧颈部手术后出现颈部肿胀的情况下，应充分认识到CL作为鉴别诊断的可能性。头颈外科医生在为接受右侧颈部手术的患者签署知情同意书时，应当考虑到CL的风险。

关键词：耳鼻喉科；耳鼻喉科学/头颈外科；内分泌系统；内分泌学；甲状腺疾病。

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