Spectrum of Advanced Upper Airway Obstruction due to Goiters

Karbowitz, Stephen; Edelman, Leonard B.; Nath, Sunil; Dwek, Joe H.; Gumpeni, Rammohan

doi:10.1378/chest.87.1.18

Cited by 22 publications

(12 citation statements)

References 9 publications

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“…Lower percentages of UAO and the differences compared with other studies may be due to the possible smaller size of the goiters or possible lower percentage of penetration in the mediastinum. On the other hand, previous studies have not observed a relationship between the physical characteristics of the goiters, their size, or the percentage of retrosternal goiter (2,16,17).…”

Section: Discussionmentioning

confidence: 70%

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: Discussionmentioning

confidence: 70%

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 spite of Hedenus reporting successful thyroidectomies in six patients for goiters, which he described as "suffocating" [20] in 1821, nowadays airway obstruction due to goiter is exceptionally reported in literature [2-5,7,9,14] due to improved diagnostic methods and earlier treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Total thyroidectomy is a routine elective operation, but exceptionally it has to be performed on an emergency basis especially when it is life-threatening due to airway obstruction [1-5]. …”

Section: Introductionmentioning

confidence: 99%

Emergency total thyroidectomy due to non traumatic disease. Experience of a surgical unit and literature review

et al. 2012

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BackgroundAcute respiratory failure due to thyroid compression or invasion of the tracheal lumen is a surgical emergency requiring urgent management. The aim of this paper is to describe a series of six patients treated successfully in the emergency setting with total thyroidectomy due to ingravescent dyspnoea and asphyxia, as well as review related data reported in literature.MethodsDuring 2005-2010, of 919 patients treated by total thyroidectomy at our Academic Hospital, 6 (0.7%; 4 females and 2 men, mean age: 68.7 years, range 42-81 years) were treated in emergency. All the emergency operations were performed for life-threatening respiratory distress. The clinical picture at admission, clinical features, type of surgery, outcomes and complications are described. Mean duration of surgery was 146 minutes (range: 53-260).ResultsIn 3/6 (50%) a manubriotomy was necessary due to the extension of the mass into the upper mediastinum. In all cases total thyroidectomy was performed. In one case (16.7%) a parathyroid gland transplantation and in another one (16.7%) a tracheotomy was necessary due to a condition of tracheomalacia. Mean post-operative hospital stay was 6.5 days (range: 2-10 days). Histology revealed malignancy in 4/6 cases (66.7%), showing 3 primitive, and 1 secondary tumors. Morbidity consisted of 1 transient recurrent laryngeal palsy, 3 transient postoperative hypoparathyroidism, and 4 pleural effusions, treated by medical therapy in 3 and by drains in one. There was no mortality.ConclusionOn the basis of our experience and of literature review, we strongly advocate elective surgery for patients with thyroid disease at the first signs of tracheal compression. When an acute airway distress appears, an emergency life-threatening total thyroidectomy is recommended in a high-volume centre.

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“…If specific questions were asked, 45% of patients said they had shortness of breath on either exertion or when in a supine posture [7]. Compromised airflow in patients who are asymptomatic has been proven by spirometry [6-8]. Peak inspiratory flow rates have been shown to be a good indicator for urgent thyroidectomy [9].…”

Section: Discussionmentioning

confidence: 99%

“…Peak inspiratory flow rates have been shown to be a good indicator for urgent thyroidectomy [9]. Using spirometry as a screening tool, the incidence of upper airway obstruction ranged from 10% to 31% [8]. In all cases, partial or total thyroidectomies were definitive cures to relieve obstruction.…”

Section: Discussionmentioning

confidence: 99%

Benign cervical multi-nodular goiter presenting with acute airway obstruction: a case report

2010

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IntroductionBenign cervical goiters rarely cause acute airway obstruction.Case presentationWe report the case of a 64-year-old woman of African descent who presented with acute shortness of breath. She required immediate intubation and later a total thyroidectomy for a benign cervical multi-nodular goiter with no retrosternal tracheal compression.ConclusionBenign multi-nodular goiters are commonly left untreated once euthyroid. Peak inspiratory flow rates should be measured via spirometry in all goiters to assess the degree of tracheal compression. Once tracheal compression is identified, an elective total thyroidectomy should be performed to prevent morbidity and mortality from acute airway obstruction.

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Spectrum of Advanced Upper Airway Obstruction due to Goiters

Cited by 22 publications

References 9 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

Emergency total thyroidectomy due to non traumatic disease. Experience of a surgical unit and literature review

Benign cervical multi-nodular goiter presenting with acute airway obstruction: a case report

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