Thyroidectomy in patients with marked thyroid enlargement: airway management, morbidity, and outcome

The medical records of 91 patients who underwent thyroidectomy from 1990 to 1993 were reviewed to evaluate airway management and operative morbidity in patients with marked thyroid enlargement. Twenty-nine patients with marked thyroid enlargement were identified: 13 unilateral, defined by a weight of > or = 40 g (mean 122 g, range 41-380 g), and 16 bilateral, defined by a weight of > or = 80 g (mean 160 g, range 82-404 g). Twenty-five patients had compressive symptomatology, 18 had tracheal narrowing and/or displacement, 19 had substernal extension, and one had superior vena cava syndrome. Unilateral vocal cord dysfunction was present in two of three patients with carcinoma and one of 26 patients with benign disease (P = 0.03). Pathology consisted of nodular goiter (11), adenoma (5), carcinoma (3), Grave's disease (5), and toxic multinodular goiter (5). All patients had an uncomplicated endotracheal intubation without the use of a fiberoptic bronchoscope as predicted on the basis of preoperative laryngoscopic findings. Ease of intubation was unrelated to the extent of abnormality seen on imaging studies of the neck. Thyroidectomy alone was effective in relieving compressive symptoms with no incidence of nerve injury, permanent hypoparathyroidism, or tracheomalacia. Six (21%) of 29 patients had temporary hypocalcemia compared to eight (13%) of 62 patients with lesser thyroid enlargement (P = 0.36). One patient with an unresectable follicular carcinoma died from aspiration pneumonia three weeks following tracheostomy placement. Marked thyroid enlargement and upper airway compression is predominantly caused by benign disease; however, when there is associated recurrent laryngeal nerve dysfunction, carcinoma is more common.(ABSTRACT TRUNCATED AT 250 WORDS)