Goiter Size Associated with Increasing Symptoms

by Sue Pondrom •

In the preoperative evaluation of goiter, is there a correlation between goiter size and symptoms, between preoperative neck imaging abnormalities and symptoms and predictors for goiter recurrence?

Background: Substernal goiter affects up to one in 5,000 patients, with progressive growth potentially resulting in progressive dyspnea, dysphagia and untoward cosmetic changes. Thyromegaly is a common problem that regularly requires surgical treatment. Despite the large number of goiter patients, data is relatively limited, especially regarding appropriate preoperative symptomatic and radiographic assessment, as well as perioperative airway management.

Study design: Retrospective review

Setting: Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston; Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston; Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Penn.; Children’s Hospital, Boston; Division of Surgical Oncology, Endocrine Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston

Synopsis: Researchers studied data from 200 procedures performed in 198 patients. Only 2 percent of the patients presented with vocal cord paralysis. Positive correlations were noted between shortness of breath and goiter size, between globus sensation and symptoms of hyperthyroidism, between shortness of breath and tracheal compression, between the presence of preoperative dysphagia and the presence of esophageal compression and deviation, and between substernal extent and tracheal deviation. There was no correlation between goiter size and the presence of dysphagia, local discomfort, change in voice, hemoptysis or symptoms of hypothyroidism and shortness of breath and tracheal deviation. There was no correlation between the percentage of patients with airway symptoms and those with purely cervical or substernal goiter. Tracheal deviation and tracheal compression were far more common than esophageal deviation and compression.

Bottom line: Goiter size is associated with increasing symptoms and tracheal compression, but not deviation.

Citation: Shin JJ, Grillo HC, Mathisen D, et al. The surgical management of goiter: part I. preoperative evaluation. Laryngoscope. 2011;121:60-67.

—Reviewed by Sue Pondrom