The impact of goitre and its treatment on the trachea, airflow, oesophagus and swallowing function. A systematic review

Sørensen, Jesper Roed; Kruse-Andersen, S; Godballe, Christian; Bonnema, Steen Joop

doi:10.1016/j.beem.2014.03.002

Cited by 40 publications

(21 citation statements)

References 57 publications

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“…Any expansion of the tracheal lumen will thus lead to a considerable improvement in air flow rate. However, a negative transmural pressure gradient across the tracheal wall may lead to a partial collapse of the tracheal rings encircling a stenosis, which is a risk mainly during inspiration [6]. Our results are fully in accordance with this physical principle, since the tracheal decompression obtained by surgery resulted in an improvement, especially in the inspiratory airflow, while the expiratory parameter FEF 50% in fact decreased minutely.…”

Section: Discussionsupporting

confidence: 79%

“…Several studies have shown that thyroidectomy improves tracheal airflow [19, 20]. However, with the exception of case studies reporting the risk of tracheomalacia and collapsed airways following thyroidectomy [20-22], no data are available on the change in tracheal anatomy after surgery [6] or on how this affects HRQoL.…”

Section: Introductionmentioning

confidence: 99%

“…The treatment strategy depends on a number of factors, including risk or fear of malignancy, as well as patient discomfort and preference, with the overall goal of improving health-related quality of life (HRQoL). Current treatment options comprise surgery [6], shown to substantially improve HRQoL [7], radioiodine [8, 9], ethanol sclerotherapy [10, 11], and ultrasound-guided interventional ablation, with laser or radiofrequency as the most used modalities [5, 11, 12]. …”

Section: Introductionmentioning

confidence: 99%

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Thyroidectomy Improves Tracheal Anatomy and Airflow in Patients with Nodular Goiter: A Prospective Cohort Study

Sørensen¹,

Lauridsen²,

Døssing³

et al. 2017

Eur Thyroid J

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Objective: A large goiter may cause compression of the trachea. The aim of this study was to investigate the impact of thyroidectomy on tracheal anatomy and airflow and to correlate this with changes in health-related quality of life (HRQoL) in patients with benign nodular goiter. Methods: Magnetic resonance images of the neck and respiratory flow-volume curves, including both inspiration and expiration, were performed prior to and 6 months following surgery. HRQoL was measured by selected scales from the thyroid-specific patient-reported outcome (ThyPRO). Cohen’s effect size (ES) was calculated as mean change divided by standard deviation at baseline. ES of 0.2–0.5 were defined as small, 0.5–0.8 as moderate, and values >0.8 as large. Results: Sixty-five patients completed all examinations. Median goiter volume was 58 mL (range, 14–642 mL) before surgery with surgical removal of a median of 43 g (range, 8–607 g). Six months after surgery, tracheal narrowing and deviation were diminished by a median of 26% (ES = 0.67, p < 0.001) and 33% (ES = 0.61, p < 0.001), respectively. Correspondingly, each 10% decrease in goiter volume resulted in 1.0% less tracheal narrowing (p < 0.001). Concomitantly, a small improvement was seen in forced inspiratory flow at 50% of forced vital capacity (ES = 0.32, p < 0.001). A reduction in tracheal narrowing was associated with improvements in the Impaired Daily Life scale (0.33 points per 1% decrease in tracheal narrowing, p = 0.03) of the ThyPRO questionnaire. Conclusions: In patients with symptomatic benign nodular goiter, thyroidectomy resulted in substantial improvements in tracheal anatomy and improvements in inspiratory flow, which were followed by gains in HRQoL. This information is pertinent when counseling patients before choice of treatment.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Thyroidectomy Improves Tracheal Anatomy and Airflow in Patients with Nodular Goiter: A Prospective Cohort Study

Sørensen¹,

Lauridsen²,

Døssing³

et al. 2017

Eur Thyroid J

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“…Sørensen et al [29] have recently published a readable review (the first one on this topic) trying to find the impact of goiter and its therapy on adjacent organs, such as trachea, esophagus and so on. In the paragraph, ''effect of thyroidectomy on the trachea and respiratory and oesophageal function'' they appeal to the same articles mentioned in this paper, Scerrino et al's one and our own article [10,18].…”

Section: Discussionmentioning

confidence: 99%

How uncomplicated total thyroidectomy could aggravate the laryngopharyngeal reflux disease?

Cusimano

Macaione

Fiorentino

2015

Eur Arch Otorhinolaryngol

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Swallowing, voice disorders, throat discomfort and subjective neck discomfort are usually reported by patients with a known thyroid nodule and are correlated to nodular thyroid disease itself. Moreover, in endemic goitrous areas, total thyroidectomy (TT) is the most frequently performed surgical procedure. We are used to relate swallowing, voice and throat discomfort to the mechanical effects of nodular goiter or to thyroidectomy itself, but in both these cases the relationship between symptoms and the thyroid mass or its removal is not always clear or easily demonstrated. How can we explain the persistence of local neck symptoms after TT? And how can TT worsen the dysphagic or dysphonic disorders attributed to the goiter's effect over the surrounding structures? During these years, many articles have analyzed the relationship between the thyroid disease and the laryngopharyngeal reflux, finding more and more evidences of their consensuality, leading to important new management considerations and notable medico-legal implications; if the reason of local neck symptoms is not the thyroid disease, we have to study and specially cure the reflux disease, with specific test and drugs. Therefore, the aim of our study, relying on the published literature, was to investigate how, in demonstrated presence of reflux laryngopharyngitis in patients with nodular goiter and local neck symptoms before and after uncomplicated TT, the surgery could influence our anti-reflux mechanism analyzing the anatomical connection as well as the functional coordination; can we play a part in the post-operative persistence of swallowing and voice alterations and throat discomfort?

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“…En cas de doute, le patient sera adressé à un méde-cin endocrinologue. Les symptômes dus à une compression locale répondent mieux à une prise en charge chirurgicale [21,22]. Le traitement radio-isotonique par l'iode 131 sous stimulation par TSH recombinante humaine a récemment démontré un intérêt dans le traitement des goitres multinodulaires, symptomatiques, bénins et non toxiques [23].…”

Section: Discussionunclassified

Syndrome d’Ascher : cas clinique et revue de la littérature

Regnault

Catros

Fricain

2015

Med Buccale Chir Buccale

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Résumé -Introduction :Le syndrome d'Ascher (SA) a été décrit pour la première fois en 1920 par Ascher. Le SA est caractérisé par l'association d'une tuméfaction du versant muqueux de la lèvre supérieure réalisant une double lèvre, un blépharochalasis bilatéral et un goitre thyroïdien non toxique (non indispensable au diagnostic). Observation : Un patient de 30 ans sans antécédent médico-chirurgical consultait pour une double lèvre responsable d'un désagrément esthétique. L'interrogatoire révélait l'apparition de la double lèvre à l'adolescence. L'examen clinique confirmait la double lèvre et mettait en évidence un prolapsus des paupières supérieures avec un ptosis plus accentué à droite. Une exérèse au laser diode de la double lèvre était réalisée sous anesthésie locale. Discussion : Des cas de double lèvres ne rentrant pas dans le cadre d'un SA ont été décrits. La lèvre supérieure est le plus souvent atteinte mais des cas touchant la lèvre inférieure ou les deux lèvres ont été décrits. Les doubles lèvres seraient dues à une hypertrophie du chorion sans participation du muscle orbiculaire. La majorité des auteurs réalisent une incision elliptique associée à une plastie en Z ou W pour traiter ces lésions. L'utilisation du laser diode présente plusieurs avantages : hémostase, absence de suture, rapidité et simplicité du geste et diminution des suites opératoires.Abstract -Ascher's syndrome: case report and review of the literature.

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The impact of goitre and its treatment on the trachea, airflow, oesophagus and swallowing function. A systematic review

Cited by 40 publications

References 57 publications

Thyroidectomy Improves Tracheal Anatomy and Airflow in Patients with Nodular Goiter: A Prospective Cohort Study

Thyroidectomy Improves Tracheal Anatomy and Airflow in Patients with Nodular Goiter: A Prospective Cohort Study

How uncomplicated total thyroidectomy could aggravate the laryngopharyngeal reflux disease?

Syndrome d’Ascher : cas clinique et revue de la littérature

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