Upper Airway Obstruction in Patients with Goiter Studied by Flow Volume Loops and Effect of Thyroidectomy

Abstract

The patient with goiter and his or her physician frequently overlook symptoms of upper respiratory obstruction. Conventional radiology is the accepted method for detecting upper airway obstruction in these patients. Flow volume loops provide additional information on airflow dynamics. Twenty-five patients of goiter undergoing surgery were evaluated for upper airway obstruction by symptomatology, conventional radiology, and flow volume loops. Flow volume loops were repeated 1 month after surgery. Ten (40%) patients had mild symptoms on direct questioning. Tracheal deviation, compression, or both were noted in eight (32%) patients on radiology. Flow volume loops detected upper airway obstruction in 15 (60%) patients. Surgery resulted in normalization of all preoperative abnormal curves. The flow volume loop is a simple noninvasive method for detecting upper airway obstruction in patients with goiter. Abnormal upper airway dynamics are present in more patients with goiter than previously recognized, and relief of this obstruction should be an important aspect of thyroid surgery.

Upper airway obstruction in patients with endothoracic goiter enlargement: no relationship between flow-volume loops and radiological tests

“…The frequency of UAO in subjects with endothoracic goiter enlargement in this study was 26%, a frequency somewhat lower than those described for patients with goiter in most of the studies (1)(2)(3)(4)(5). Given that the endothoracic goiter enlargement present in our subjects favors UAO, it is surprising that this percentage is so clearly lower than that described in patients with or without endothoracic goiter.…”

“…On the other hand, treatment of asymptomatic UAO subjects has been questioned (2), although studies show a postintervention improvement in FVL (2,3,5,7,24). A prospective study would be necessary to evaluate the evolution of the subjects suffering from asymptomatic goiter with endothoracic enlargement and UAO in order to determine if the detection of UAO is an indication for surgery.…”

“…Prevalence according to existing studies ranges between 16 and 85% (1)(2)(3)(4)(5), and this wide range may be due to the differences in inclusion criteria of the population in question (6).…”

“…The evaluation of FVL obtained during maximum forced spirometry inspirations and expirations by an expert is the most sensitive and specific test in determining UAO (5). Functional respiratory tests after surgery show an improvement in over 90% of all cases (3,5). However, the degree of patient effort and the degree of cooperation added to observer experience are associated with errors in the interpretation of FVL.…”

“…Clinical or functional signs of UAO in subjects with goiter are considered to be indications for surgical treatment, including in elderly patients (2,3,6); yet !50% of these patients present symptoms (2,7), which suggests that clinical history seldom predicts the presence of UAO. Furthermore, the correlation between radiological indices and flow-volume loops (FVL) in subjects with UAO due to goiter enlargement is low (5,8), and there also exists discrepancies between radiological test and clinical test correlations (9).…”