Orthopnea and Tidal Expiratory Flow Limitation in Patients With Euthyroid Goiter

Torchio, Roberto; Gulotta, Carlo; Perboni, Alberto; Ciacco, Claudio; Guglielmo, Marco; Orlandi, Fabio; Milic–Emili, J.

doi:10.1378/chest.124.1.133

Cited by 38 publications

(14 citation statements)

References 16 publications

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“…When we compared these results with prior studies, while a decreased frequency of dyspnea and dysphonia was observed, there was a greater presence of dysphagia (9). The presence of UAO could not be correlated with stenosis, tracheal deviation, or results of CT on tracheal compression, despite being evaluated with the visual analysis of FVL or using the ratio of cutoff points FEF 50 /FIF 50 O1.2 or FEV 1 /PEF O8, described previously in the literature (5,21). This is reinforced in the results of other studies (8,22).…”

Section: Discussionsupporting

confidence: 56%

Upper airway obstruction in patients with endothoracic goiter enlargement: no relationship between flow-volume loops and radiological tests

Albareda

Viguera²,

Santiveri³

et al. 2010

European Journal of Endocrinology

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Background: In about 16-85% of subjects with goiter, upper airway obstruction (UAO) is observed. This percentage is higher in patients affected by goiter with endothoracic enlargement. UAO is an indication for surgery. Visual analysis of flow-volume loops (FVL) are the best indicators for UAO, although various studies using clinical and radiological parameters have observed no correlation. Objective: To evaluate the presence of UAO in patients with endothoracic goiter enlargement and the relationship between the FVL with the observed symptoms and the measurements obtained by computed tomography (CT). Subjects: Subjects with endothoracic goiter enlargement participated in the study. Design: i) Symptom questionnaire (dysphagia, dyspnea, cough, oppression, dysphonia, and worsened symptoms when prone); ii) analysis: TSH and free thyroxine; iii) cervical ultrasound; iv) cervicalthoracic CT (measurements of area and diameter in the area of maximum stenosis and at 2 cm from the carina); v) chest radiography and vi) forced spirometry: visual analysis of FVL morphology and the maximum forced expiratory volume in 1 s (FEV 1 ), forced expiratory flow at 50% vital capacity/forced inspiratory flow at 50% vital capacity and FEV 1 /peak expiratory flow parameters. Results: Fifty subjects participated in the study: 11 men/39 women, median age 73.8 years (43.76-88.43). UAO was diagnosed in 13 cases (26%, confidence interval: 14.6-40.3%) and 27 subjects (54%) presented symptoms suggesting goiter compression. No clinical or radiological variables showed the presence of UAO. Conclusions: The frequency of UAO in subjects affected by goiter with endothoracic enlargement was lower than that described for goiter patients, and there were no clinical or radiological indicators to establish its presence.

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Section: Discussionsupporting

confidence: 56%

Upper airway obstruction in patients with endothoracic goiter enlargement: no relationship between flow-volume loops and radiological tests

Albareda

Viguera²,

Santiveri³

et al. 2010

European Journal of Endocrinology

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“…In conclusion, the NEP technique has been used clinically in studies with the following: 1) COPD (during mechanical ventilation and exercise, correlation with dyspnoea, orthopnoea, and other lung function indexes, before and after bronchodilatation, various postures) [22-25, 27, 33, 42, 43, 49, 50]; 2) asthma (stable asthma, during MCh bronchocostriction, and during exercise) [28,[44][45][46]; 3) cystic fibrosis [52,53] and bronchiectasis [54]; 4) restrictive lung disease [33,37]; 5) obesity [32,55,56]; 6) mechanically ventilated with acute respiratory failure and ARDS [7,8,23,[30][31][32]; 7) left heart failure [57]; 8) after single lung transplantation [29,58]; 9) euthyroid goitre [59]; and 10) assessment of bronchial hyperreactivity [60]. It appears that the use of the NEP technique during tidal flow-volume analysis studies has led to the realisation of the important role of EFL in exertional dyspnoea and ventilatory impairment for a surprisingly wide range of clinical circumstances [61].…”

Section: Clinical Applicationsmentioning

confidence: 99%

Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

Calverley¹

2005

Eur Respir J

224

168

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Fashions in ideas, like clothes, come and go. From approximately 1950From approximately -1980, physiological research was seen as the key discipline in understanding lung disease and was at the cutting edge of pulmonary science. Subsequently, its importance has been down played amid a widely accepted but unfounded assumption that we now have a perfect working understanding of the physiological behaviour of the respiratory system in health and disease. Although it seems improbable that completely new disciplines within respiratory physiology will emerge with fundamentally different ways of describing the mechanical or gas exchanging function of the lung, advances in computing and new observations in disease have highlighted previously unsuspected physiological abnormalities that have changed the way we view lung disease and the interface between disordered lung mechanics, symptomatology and disability. This is especially true for the two related physiological concepts of expiratory flow limitation and dynamic hyperinflation, which are now being taken from the physiological laboratory to the bedside with dramatic effect. Each arises from well-established theoretical and practical observations first made 40 yrs ago and now adapted to a range of settings, particularly in the field of obstructive lung disease. This review focuses on how these conditions are defined and assessed and what evidence there is that they might be important in lung disease.

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“…Evaluation should then be followed with a chest XRay and CT scan with IV contrast to further assess location and size of the mass as well as severity of cardiorespiratory compromise [1,5]. Data are conflicted regarding the utility of PFTs and flow-volume loops in assessing a patient's cardiorespiratory risk [6][7][8]. Only one patient in our series underwent pre-operative spirometry.…”

Section: Discussionmentioning

confidence: 99%

A multidisciplinary approach to the management of anterior mediastinal masses in children

Acker

Linton

Tan

et al. 2015

Journal of Pediatric Surgery

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Orthopnea and Tidal Expiratory Flow Limitation in Patients With Euthyroid Goiter

Cited by 38 publications

References 16 publications

Upper airway obstruction in patients with endothoracic goiter enlargement: no relationship between flow-volume loops and radiological tests

Upper airway obstruction in patients with endothoracic goiter enlargement: no relationship between flow-volume loops and radiological tests

Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

A multidisciplinary approach to the management of anterior mediastinal masses in children

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