Outcomes of Total Thyroidectomy in Large Goiters With Retrosternal Extension and Tracheal Compression: A Multivariate...

Area of Science:

• Endocrinology
• Surgical Oncology
• Otolaryngology

Background:

• Retrosternal goiters can cause significant tracheal compression and deviation, leading to respiratory distress.
• Total thyroidectomy is the standard treatment but poses surgical risks due to altered anatomy near vital structures.

Purpose of the Study:

• To evaluate the outcomes of total thyroidectomy in patients with retrosternal goiters.
• To assess the impact of tracheal compression on clinical results and surgical complications.

Main Methods:

• Retrospective analysis of 32 patients undergoing total thyroidectomy for retrosternal goiter (January 2018 - June 2024).
• Evaluation of clinical presentation, tracheal status (compression/deviation via imaging and bronchoscopy), intubation, surgical details, and postoperative complications.
• Correlation analysis between difficult intubation and tracheal status.

Main Results:

• Tracheal deviation occurred in 62.5% and compression in 43.8% of patients.
• Postoperative complications included hypocalcemia (43.8%), recurrent laryngeal nerve palsy (6.25%), and tracheomalacia (15.6%).
• Flexible fiberoptic-assisted intubation was frequently necessary; malignant goiters showed higher deviation and complication rates.

Conclusions:

• Retrosternal goiters pose risks of airway compromise and surgical complications, particularly with tracheal compression.
• Preoperative assessment of tracheal involvement and tailored surgical strategies are crucial for managing airway issues and improving outcomes.
• A multidisciplinary approach is recommended for optimal patient management.