Positional Dyspnea and Tracheal Compression as Indications for Goiter Resection

Abstract

Hypotheses: Goiter is a surgically reversible cause of positional dyspnea (PD). Substernal tracheal compression (TC) predicts PD relief after thyroidectomy (Tx). Design: Retrospective analysis of a prospective structured management algorithm. Setting: Endocrine surgery academic center. Methods: Before Tx, 1081 patients were queried about PD. Those patients with substernal goiter underwent computed tomography, and their degree of TC was estimated as greatest percent reduction of transverse tracheal diameter. For 197 patients with PD, TC, or both, surgical outcomes were examined with a mean follow-up of 12.6 months. After Tx, patients who carried the diagnosis of obstructive sleep apnea were referred for repeat sleep study evaluation. Results: Positional dyspnea was reported by 188 of 1081 patients, and after Tx the PD improved or resolved in 82.4%. In the 151 patients with substernal goiter, TC was present on imaging in 97.2%; the mean (range) TC was 34% (5%-90%). Patients with TC had a high likelihood of PD (93.5%). After substernal goiter resection, PD improved in stepwise association with total resected thyroid gland weight. Improvement in PD was strongly predicted by both gland weight of 100 g or more (PϽ.001) and by TC of 35% or more (P Ͻ.01). After Tx, 59 of 77 snorers (76.6%) reported improvement in snoring, 77.1% of patients with obstructive sleep apnea reported improved PD, and 2 of 3 retested patients with obstructive sleep apnea demonstrated objective improvement in sleep study apnea-hypopnea index. Conclusions: Resection of bulky goiter frequently improves PD, which in substernal goiter is highly associated with TC. Either PD or TC of 35% or more prompt Tx. Goiter should be considered when obstructive sleep apnea is diagnosed.

Substernal goiter and laryngopharyngeal reflux

“…The authors report those inferences from their surgical experience and theoretical study of cervical and thoracic anatomy. Moreover, the present series has substernal goiters up to 266.6 cc, which can cause direct compressive symptoms in different cervical structures such as the trachea (23,24), and the superior vena cava (25).…”

Recurrent dyspnea and wheezing- pulmonary function test and dynamic computed tomography may unfold the diagnosis of tracheobronchomalacia

“…Narrowing the differential diagnosis can miss alternative treatable conditions and lost opportunity [3,4,5]. Positional dyspnea and wheezing are commonly seen with congestive heart failure, goiter, OSA, and lung cancer [1,2], but this patient’s history and our findings on examination did not suggest those conditions. Abnormal PFT during sitting upright and supine positions led to a suspicion of a significant airway disease such as tracheobronchomalacia, which was confirmed by dynamic chest CT.…”

“…Other causes of segmental tracheomalacia include prolonged external pressure on the tracheal wall by a large substernal goiter or a congenital vascular ring [1,8]. More diffuse TM can be seen with relapsing polychondritis.…”

“…Environmental triggers and smoking are commonly associated with their exacerbation. Orthopnea (dyspnea in the recumbent position), though not a physical finding in obstructive lung diseases, is seen with congestive heart failure, obstructive sleep apnea (OSA), morbid obesity, goiter, bronchogenic carcinoma, and tracheobronchomalacia (TBM) [1,2]. Structural obstruction of airway in conditions such as TBM can elicit a symptom of positional dyspnea, more pronounced when lying flat, in association with other findings consistent with obstructive lung diseases, making the diagnosis difficult.…”

Computed tomography in diagnostics of extravasal influence of thyroid nodules

“…Некоторые авторы [9] развитие такого син-дрома считают редким явлением. Диагностике и ле-чению компрессии трахеи и пищевода посвящено довольно много публикаций [1,7,10,11]. В немно-гочисленных статьях последних лет появились дан-ные о том, что УО ЩЖ, сдавливая общие сонные артерии и внутренние яремные вены, ухудшают мозговое кровообращение, вызывают головокруже-ние, слабость, снижение памяти [8], приводят к раз-витию венозной энцефалопатии, сопровождающей- Цель исследования -оценить информативность мультиспиральной компьютерной томографии с внутривенным кон-трастированием (МСКТК) в выявлении компрессии общих сонных артерий и внутренних яремных вен узловыми обра-зованиями щитовидной железы.…”