Upper Airway Obstruction in Euthyroid Goiter

Abstract

Although it is recognized that an enlarged thyroid may occasionally cause tracheal compression, the incidence in euthyroid goiter is unknown. Twenty patients with nontoxic goiter were investigated for upper airway obstruction. Although none of them had dyspnea as a chief complaint, on direct questioning 9/20 had a history of shortness of breath on exertion and choking sensation. Upper airway obstruction was detected in 7/20 (35%) by roentgenography, 12/20 (60%) by flow volume loop (FVL), and in 16/20 (80%) by combined roentgenography and FVL. After therapy for goiter, there was a reduction in the size of the goiter and an improvement in FVL in the whole group. The statistically significant change occurred in peak expiratory flow (P less than .01) and peak inspiratory flow (P less than .05). These findings and the change in configuration of the curve suggested less upper airway compression. We conclude that goiter often causes unsuspected upper airway obstruction, usually slow in onset and not noticed by the patient.

Prevalence of upper airway obstruction in patients with apparently asymptomatic euthyroid multi nodular goitre

“…Moreover, one of the studies which reported the highest prevalence of 60% did not exclude patients with chronic obstructive lung disease and recurrent left ventricular failure. [16] Lower incidence in our study may also be due to stricter criteria to define UAO.…”

“…Previous studies have reported a higher incidence (33–60%) of UAO in euthyroid MNG subjects;[371516] however, they have not excluded overtly symptomatic patients. Moreover, one of the studies which reported the highest prevalence of 60% did not exclude patients with chronic obstructive lung disease and recurrent left ventricular failure.…”

An unusual cause of dyspnoea

“…Conventional radiology is the accepted method for detecting upper airway obstruction in these patients 1. In this case a chest radiograph helped to make the diagnosis and computed tomography confirmed it.…”

Quick recognition of a threatened airway in a patient with a swelling in the neck

“…Symptoms develop through compression of vital structures in the neck or upper thoracic cavity. A large goitre can even lead to tracheal compression 2. This image shows an impressively large goitre that is not seen regularly in Western countries, but should be recognised as a potentially dangerous condition.…”