Goiter with severe respiratory compromise: evaluation and treatment

Area of Science:

• Endocrinology
• Thoracic Surgery
• Surgical Oncology

Background:

• Goiter with major respiratory compromise is an uncommon yet challenging clinical scenario.
• Management strategies for this condition remain a subject of debate.
• A significant retrospective review of 2,908 goiter surgeries identified 58 cases with respiratory complications.

Purpose of the Study:

• To retrospectively analyze 58 cases of goiter with respiratory compromise.
• To define optimal management strategies for goiter-associated respiratory distress.
• To evaluate the incidence of carcinoma in patients with compressive goiter.

Main Methods:

• Retrospective analysis of 58 patients with goiter and respiratory compromise from a larger cohort of 2,908 goiter surgeries over 17 years.
• Categorization of patients based on the severity of dyspnea (acute/severe vs. chronic).
• Review of surgical outcomes, complications, and pathological findings, including carcinoma detection.

Main Results:

• Fifty percent of patients with acute dyspnea and 11% with chronic dyspnea had concurrent carcinoma.
• Long-standing goiter tolerance did not rule out compressive respiratory distress or malignancy.
• Cervicotomy without sternotomy was successful in 92% of cases, with minimal morbidity.
• Endotracheal intubation effectively managed respiratory distress, often avoiding tracheostomy.

Conclusions:

• Optimal management involves delaying surgery until favorable operating conditions and diagnostic certainty are achieved.
• Preventive removal of large or substernal goiters is suggested to avoid potential complications.
• Tracheal intubation is a safe and effective method for managing acute respiratory distress in goiter patients.