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Wen T. Shen, MD; Electron Kebebew, MD; Quan-Yang Duh, MD; Orlo H. Clark, MD

Arch Surg. 2004;139:656-660.

Hypothesis  Airway complications after thyroidectomy for substernal goiter can be predicted by preoperative symptom profiles, radiologic findings, or other factors.

Design  Retrospective review.

Settings  A university tertiary care center and a veterans' hospital.

Patients  Sixty patients with substernal goiter who underwent thyroidectomy between 1993 and 2002.

Main Outcome Measures  Symptoms, preoperative radiologic findings, extent of thyroid resection, tumor size, and postoperative complications.

Results  Dysphagia was the most common preoperative symptom (n = 26), followed by dyspnea (n = 21), orthopnea (n = 13), and hoarseness (n = 6); 18 patients (30%) had superior vena caval obstruction. Thirteen patients (22%) were asymptomatic. Preoperative imaging identified tracheal deviation or compression in 45 patients (75%). Substernal goiter was resected via a cervical approach in 59 patients (98%). Of 47 patients with preoperative symptoms, 41 (87%) reported improvement postoperatively. Seven patients (12%) had postoperative airway complications: 1 developed a neck hematoma requiring reoperation, and 6 could not be immediately extubated; all 6 were successfully extubated after 1 to 10 days. Patients with airway complications were older (mean ± SEM, 70.3 ± 3.6 years vs 61.5 ± 2.2 years), had larger goiters (mean ± SEM, 210.7 ± 37.0 g vs 112.2 ± 7.7 g), and were more likely to have tracheal compression on preoperative imaging than those who did not have complications (P<.05).

Conclusions  Most patients with substernal goiters underwent thyroid resection via a cervical approach with an improvement in symptoms. The few patients who developed postoperative airway complications were older, had larger goiters, and were more likely to have tracheal compression on preoperative imaging than those without airway complications.

From the Department of Surgery, University of California, San Francisco.

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Increased Mortality and Morbidity Associated With Thyroidectomy for Intrathoracic Goiters Reaching the Carina Tracheae
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Arch Surg 2006;141:82-85.
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