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Chest X-ray Prior to Thyroidectomy: Is It Really Needed?

Alexandra Mikhael1, Rushad Patell2, Michael Tabet3

  • 1Internal Medicine Department, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. mikhaea@ccf.org.

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|November 18, 2017
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Summary

Routine preoperative chest X-rays (CXRs) before thyroid surgery offer limited utility. Most CXR abnormalities do not impact patient management, suggesting this practice may be unnecessary.

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Area of Science:

  • Radiology
  • Endocrine Surgery
  • Thoracic Medicine

Background:

  • Routine preoperative chest X-ray (CXR) is common before thyroid surgery, despite a lack of evidence supporting its usefulness.
  • This study evaluates the diagnostic value of preoperative CXR in thyroidectomy patients at a single institution.

Purpose of the Study:

  • To determine the clinical utility of preoperative chest X-ray (CXR) in patients undergoing thyroidectomy.
  • To assess the correlation between CXR abnormalities and factors like difficult intubation and cancer stage.

Main Methods:

  • A retrospective review of 594 thyroidectomy patients was conducted.
  • Data collected included demographics, CXR findings, anesthesia records, and pathology results.
  • The study investigated correlations between CXR abnormalities, difficult intubation, and cancer staging.

Main Results:

  • 56% of patients had at least one CXR abnormality, most commonly skeletal abnormalities (25%) and tracheal deviation (16%).
  • Tracheal deviation on CXR rarely predicted difficult intubation (5%) and was more frequent in non-cancer cases.
  • CXR findings altered management in only 4% of cases; higher cancer T-stage correlated with increased tracheal deviation.

Conclusions:

  • Preoperative chest X-ray (CXR) has very limited utility in routine thyroidectomy evaluations.
  • Given the low impact on management and the move towards value-based care, routine CXR before thyroid surgery is likely redundant and should be reserved for specific clinical indications.