The surgical management of goiter: Part I. preoperative evaluation

• Published in: The Laryngoscope 2011-01, Vol.121 (1), p.60-67
• Main Authors: Shin, Jennifer J., Grillo, Hermes C., Mathisen, Doug, Katlic, Mark R., Zurakowski, David, Kamani, Dipti, Randolph, Gregory W.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Airway Obstruction - etiology; Biological and medical sciences; Deglutition Disorders - etiology; Endocrinopathies; Female; Goiter; Goiter - complications; Goiter - diagnosis; Goiter - pathology; Goiter - surgery; Goiter, Substernal - complications; Goiter, Substernal - diagnosis; Goiter, Substernal - pathology; Goiter, Substernal - surgery; Humans; Level of Evidence: 3b; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Otorhinolaryngology. Stomatology; recurrent laryngeal nerve injury; substernal goiter; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of endocrine glands; thyro-megaly; thyroid disease management; thyroid neoplasm; thyroid surgery; Thyroid. Thyroid axis (diseases); Thyroidectomy; Young Adult
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.21084

Objectives/Hypothesis: Our overarching objective is to provide a comprehensive analysis of goiter data in two paired articles. This first article focuses on the preoperative evaluation. The following null hypotheses have been tested: 1) there is no correlation between goiter size and preoperative symptoms, 2) there is no correlation between preoperative neck imaging abnormalities and preoperative symptoms, and 3) there are no predictors for goiter recurrence. Sudy Design: A retrospective review of 200 consecutive thyroidectomies meeting inclusion/exclusion criteria for cervical or substernal goiter. Results: The mean specimen size was 10.5 ± 4.8 cm and 142.9 ± 113.3 grams. There was a positive correlation between goiter size and preoperative shortness of breath (P = .02). The presence of substernal goiter was significantly correlated with tracheal deviation and tracheal compression (P < .01) on neck imaging. There was strong correlation between preoperative shortness of breath and tracheal compression (P < .001) on neck computed tomography (CT), but not tracheal deviation. The need for revision surgery was significantly associated with female gender (odds ratio 3.0; 95% confidence interval [CI] 1.5, 6.1, and a positive family history of thyroid disease (odds ratio 6.5 [2.4, 17.3]). Conclusions: Goiter size is associated with increasing symptoms. Tracheal compression but not deviation was related to shortness of breath. Females and patients with a positive family history of goiter have an increased risk of goiter recurrence. Laryngoscope, 2011