The surgical management of goiter: Part I. preoperative evaluation

Shin, Jennifer J.; Grillo, Hermes C.; Mathisen, Doug; Katlic, Mark R.; Zurakowski, David; Kamani, Dipti; Randolph, Gregory W.

doi:10.1002/lary.21084

Cited by 41 publications

(37 citation statements)

References 24 publications

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“…A study on patients with substernal goiter investigating dysphagia and esophageal compression, detected by computed tomography, did not identify any correlation, but the study was characterized by a small number of highly selected patients [24]. Other studies found positive correlations between esophageal compression and symptoms [22, 23], but definitions of esophageal compression and deviation were lacking, thereby hindering meaningful comparisons with our results. A retrospective study on 198 patients found a positive correlation (of unreported magnitude) between preoperative dysphagia and image findings, without defining what these findings represented [23].…”

Section: Discussioncontrasting

confidence: 44%

“…Other studies found positive correlations between esophageal compression and symptoms [22, 23], but definitions of esophageal compression and deviation were lacking, thereby hindering meaningful comparisons with our results. A retrospective study on 198 patients found a positive correlation (of unreported magnitude) between preoperative dysphagia and image findings, without defining what these findings represented [23]. A previous study by our group found no major association between esophageal motility disturbances and swallowing difficulties in patients with goiter [27], but that study may have been underpowered as it included only 33 patients.…”

Section: Discussioncontrasting

confidence: 43%

“…Esophageal compression and esophageal deviation on radiographic images are reported in 8–27% of patients with goiter [22, 23], and the ill-defined globus sensation seems to be linked to tracheo-esophageal deviation [24]. However, there is no clear definition of either esophageal compression or esophageal deviation, which impedes any attempt at interpreting alterations in these parameters following therapy.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Esophageal Compression on Goiter Symptoms before and after Thyroid Surgery

Brinch¹,

Døssing²,

Nguyen³

et al. 2018

Eur Thyroid J

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Introduction: Benign nodular goiter may be associated with swallowing difficulties, but insight into the associated pathophysiology is limited. The aim of this study was to investigate the effect of surgery on the degree of esophageal compression, and its correlation to swallowing difficulties. Methods: Esophageal compression and deviation were evaluated blindly on magnetic resonance imaging (MRI) of the neck, prior to and 6 months after thyroid surgery for symptomatic benign goiter. Goiter symptoms and swallowing difficulties were measured by the Goiter Symptom Scale of the Thyroid-Specific Patient-Reported Outcome (ThyPRO) questionnaire. Cohen’s d was used for evaluating effect sizes (ES). Results: Sixty-four patients completed the study. Before surgery, median goiter volume was 57 (range 14–642) mL. The smallest cross-sectional area of the esophagus (SCAE) increased from a median of 95 (47–147) to 137 (72–286) mm² (ES = 1.31, p < 0.001). Median esophagus width increased from 15 (range 10–21) to 17 (range 12–24) mm (ES = 0.94, p < 0.001) after surgery, while no statistically significant change was observed for the sagittal dimension (anterior-to-posterior), thus reflecting an increasingly ellipsoid esophageal shape. Median esophageal deviation decreased moderately after surgery from 4 (0–23) to 3 (0–10) mm (ES = 0.54, p = 0.005). The goiter symptom score improved considerably from (mean ± SD) 40 ± 21 to 10 ± 10 points (ES = 1.5, p < 0.001) after surgery, and the improvements were associated with improvements in SCAE (p = 0.03). Conclusions: In patients with goiter, thyroidectomy leads to substantial improvements in esophageal anatomy, as assessed by MRI, and this correlates with improved swallowing symptoms. This information is valuable in qualifying the dialogue with goiter patients, before deciding on the mode of therapy. Clinicaltrials.gov (NCT03072654).

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Section: Discussioncontrasting

confidence: 44%

Section: Discussioncontrasting

confidence: 43%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Impact of Esophageal Compression on Goiter Symptoms before and after Thyroid Surgery

Brinch¹,

Døssing²,

Nguyen³

et al. 2018

Eur Thyroid J

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“…It was recently demonstrated that tracheal compression but not deviation was related to shortness of breath. 22 The displacement of the trachea is always accompanied by a certain amount of curving of the trachea upon itself, and frequently by some twisting of the trachea upon its long axis. In very rare cases the trachea is displaced directly or obliquely forwards.…”

Section: Discussionmentioning

confidence: 99%

Surgical approach to the intrathoracic goiter

Vaiman

Bekerman

Jabarin

et al. 2018

Laryngoscope Investig Oto

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ObjectiveIn a retrospective study, the authors analyzed the surgical approach to the intrathoracic goiter to avoid sternotomy or thoracotomy.MethodsWe selected 70 intrathoracic cases of multinodular goiter out of 988 cases of thyroidectomy and compared them with cervical goiter cases. Surgical technique, results, and postsurgical complications were assessed.ResultsThe analyzed cases presented the retrosternal goiter (n = 53; 75.7%), the retrotracheal goiter (n = 9; 12.8%), and the retroesophageal goiter (n = 8; 11.4%). Complaining of chest pressure or discomfort was specific for intrathoracic cases (50%; 35 of 70). All goiters except one were removed via cervical incision. The surgeons used head reclination and isthmus dissection when removing sizable goiters. Mean weight of goiters was 180 g. The recurrent laryngeal nerve was more often temporarily damaged in intrathoracic cases in comparison with cervical cases (4.3% vs. 2.8%, P = .04), but the difference in permanent injury was less significant (P = .09). The incidence of temporary hypoparathyroidism was significantly higher in intrathoracic cases (P = .01).ConclusionIn cases of multinodular goiter the goiters of various extensions can be successfully removed via the cervical incision in most of the cases even if they occupy the retrosternal, retrotracheal, or retroesophageal position. The transthoracic approaches and sternotomy might be justified in malignant cases.Level of Evidence4.

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“…Occasional cases of overt hyperthyroidism have also been reported. A retrospective study by Shin et al reported a positive correlation between thyroid size and presence of shortness of breath, globus sensation, and symptoms of hyperthyroidism 3 . This study, however, did not find a correlation between goiter size and presence of dysphagia, local discomfort, changes in voice, hemoptysis, or symptoms of hypothyroidism.…”

Section: Introductionmentioning

confidence: 98%

Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

Kumar

Mohan

Dhillon

et al. 2014

JoVE

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Substernal thyroid goiter (STG) represents about 5.8% of all mediastinal lesions(1). There is a wide variation in the published incidence rates due to the lack of a standardized definition for STG. Biopsy is often required to differentiate benign from malignant lesions. Unlike cervical thyroid, the overlying sternum precludes ultrasound-guided percutaneous fine needle aspiration of STG. Consequently, surgical mediastinoscopy is performed in the majority of cases, causing significant procedure related morbidity and cost to healthcare. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) is a frequently used procedure for diagnosis and staging of non-small cell lung cancer (NSCLC). Minimally invasive needle biopsy for lesions adjacent to the airways can be performed under real-time ultrasound guidance using EBUS. Its safety and efficacy is well established with over 90% sensitivity and specificity. The ability to perform EBUS as an outpatient procedure with same-day discharges offers distinct morbidity and financial advantages over surgery. As physicians performing EBUS gained procedural expertise, they have attempted to diversify its role in the diagnosis of non-lymph node thoracic pathologies. We propose here a role for EBUS-TBNA in the diagnosis of substernal thyroid lesions, along with a step-by-step protocol for the procedure.

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The surgical management of goiter: Part I. preoperative evaluation

Abstract: Goiter size is associated with increasing symptoms. Tracheal compression but not deviation was related to shortness of breath. Females and patients with a positive family history of goiter have an increased risk of goiter recurrence.

Cited by 41 publications

References 24 publications

The Impact of Esophageal Compression on Goiter Symptoms before and after Thyroid Surgery

The Impact of Esophageal Compression on Goiter Symptoms before and after Thyroid Surgery

Surgical approach to the intrathoracic goiter

Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

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