Positional dyspnea and tracheal compression as indications for goiter resection

Area of Science:

• Endocrinology
• Surgical Oncology
• Pulmonology

Background:

• Goiter can cause positional dyspnea (PD), a condition that can be surgically resolved.
• Substernal tracheal compression (TC) is a key indicator for PD relief following thyroidectomy (Tx).

Purpose of the Study:

• To evaluate the efficacy of thyroidectomy in resolving positional dyspnea (PD) in patients with goiter.
• To determine the predictive value of substernal tracheal compression (TC) for PD improvement after Tx.

Main Methods:

• Retrospective analysis of a prospective structured management algorithm at an endocrine surgery center.
• 1081 patients were assessed for PD pre-thyroidectomy; CT scans evaluated TC in those with substernal goiter.
• Surgical outcomes were examined in 197 patients with PD, TC, or both, with a mean follow-up of 12.6 months.

Main Results:

• 82.4% of patients with PD experienced improvement or resolution post-thyroidectomy.
• In patients with substernal goiter, 97.2% had TC, and 93.5% with TC reported PD.
• PD improvement was associated with resected gland weight (≥100g) and TC (≥35%).

Conclusions:

• Resection of bulky goiters, particularly substernal ones with significant TC, frequently improves PD.
• Thyroidectomy is indicated for PD or TC of 35% or greater.
• Goiter should be considered in the differential diagnosis of obstructive sleep apnea.