The surgical management of goiter: Part II. Surgical treatment and results

Abstract

In this series of patients with extensive goiter, primary and revision surgery were associated with low rate of complications. Surgical complications were associated with bilateral and large goiters suggesting increased caution in these patients.

The neoplastic goitre

“…Not all experts agree with this policy and Randolph et al [26] who reviewed 200 cases of large cervical and substernal goitres, report only a 1.5% recurrence rate, despite over 60% of patients being managed by unilateral thyroid lobectomy. Although analysis of this retrospective group suggested that a positive family history and female sex were predictors of recurrence, extent of surgery was not included in this multivariate analysis.…”

“…In selected cases a full total lobectomy on the side of the smaller lobe, with division of the isthmus may be advisable. This will allow better mobilization of the dominant lobe, reducing cervical pressure and helping to locate the RLNs and the parathyroid glands more easily [26,28].…”

“…Rough manipulation of the gland must be avoided as this may cause avulsion of the internal jugular vein [26,28].…”

“…It is not uncommon for the nerve to be riding over a hyperplastic nodule, making it particularly vulnerable. With this in mind surgeons must be familiar with localization of the RLN either at the cricothyroid junction or at the level of the inferior thyroid artery (ITA) [26,28,29].…”

Surgical Management of Hyperthyroidism

“…A number of series failed to show cases of tracheomalacia [143,144], while a small number has been reported in others [145]. It has been postulated that this entity has been mistaken for unrecognised bilateral vocal cord paralysis [146]. Tracheomalacia is treated with intubation, tracheotomy, mesh repair of the posterior tracheal wall, trachelopexy and grafting.…”