[Acute respiratory failure in the course of thyroid disease]

During the past 10 years, we have treated 11 patients who were admitted with acute respiratory failure due to goiter. Multinodular goiter was examined in four patients, one patient suffered from Graves disease and six patients had malignant thyroid lesions. Four patients required emergency intubation and in two cases we performed tracheostomy because of significant narrowing of trachea lumen. Diagnosis was made in most cases based on chest x-ray films, laryngoscopic examination, CT scans of the neck and goiters fine needle aspiration biopsy. All patients underwent mostly subtotal thyroidectomy with the standard cervicotomy approach. Five patients required tracheostomy procedures after surgery, three because of local advanced malignancy and two because of postoperative respiratory failure. In two cases pneumonia developed as a postoperative complication. One patient with advanced malignant goiter died. The goiters with progress of trachea compression symptoms should be operated in elective surgery to avoid sudden life-threatening complications like severe dyspnea. When the hoarseness is present the possibility of malignant goiter is particularly high. In our opinion patients with suspected respiratory failure should be referred to the centres with special interest in thyroid surgery.