Clinicopathological Profile, Airway Management, and Outcome in Huge Multinodular Goiters: An Institutional Experience from an Endemic Goiter Region

Agarwal, Amit; Agarwal, Shikha; Tewari, Prabhat; Gupta, Sushil K.; Chand, Gyan; Mishra, Anjali; Agarwal, Gaurav; Verma, Ashok Kumar; Mishra, Saroj Kanta

doi:10.1007/s00268-012-1447-x

Cited by 35 publications

(45 citation statements)

References 22 publications

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“…The analysis of primary diagnosis in the group of patients with DI showed that the highest number of DI were present in the group of patients with multinodular goiter, followed by the group with hyperthyroidism and those with cancers, and the least in the group with nodular goiter. Since patients with multinodular goiters, as a rule, have maximum dimension of goiter, and those with nodular goiters the least thyroid size, this indirectly proves that the size of goiter has the largest share in DI occurrence, as shown by the results of a recent study by Agarwal et al 16 . The circumference and length of the neck in our study were singled out as one of the most important risk factors for DI and as an independent predictor of DI in thyroid surgery.…”

Section: Nevena Kalezić Et Alsupporting

confidence: 51%

Predictors of Difficult Airway Management in Thyroid Surgery: A Five-Year Observational Single-Center Prospective Study

Kalezić

2016

ACC

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SUMMARY -Difficult tracheal intubation (DI) is more common in thyroid than in other surgical branches due to thyromegaly. Proper preoperative airway evaluation is necessary in order to reduce the potential numerous complications. The study examined the incidence of DI in thyroid surgery and the influence of tracheal dislocation and other risk factors on DI. A prospective study was conducted on 2379 patients who underwent thyroidectomy at the Center for Endocrine Surgery, Clinical Center of Serbia, from 2007 to 2012. Patients were divided into groups with (n=162) and without DI (n=2217). Besides tracheal dislocation, another 13 risk factors contained in 13 screening tests and three additional factors of gender, age and diagnosis were defined. The incidence of DI in our study was 6.81%. The presence of tracheal dislocation was statistically significant, but not an independent predictor of DI. The diagnosis, large circumference and small neck length, previous DI, recessive mandible, tooth characteristics and oral anomalies were the most significant and independent predictors of DI. Neck circumference and small neck length had highest sensitivity. Previous DI had highest specificity. Thyromegaly, if causing tracheal dislocation and/or stenosis, represents a significant DI predictor, not individually, but in combination with other factors.

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Section: Nevena Kalezić Et Alsupporting

confidence: 51%

Predictors of Difficult Airway Management in Thyroid Surgery: A Five-Year Observational Single-Center Prospective Study

Kalezić

2016

ACC

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“…Fibrosis, another component of the TDS, is seen in Hashimoto’s thyroiditis, and contributes to higher complication rates (12). Finally, larger gland size contributes to higher complication rates, specifically airway complications and transient hypocalcemia (13, 15, 24). The TDS incorporates all of these aspects of difficulty—size, vascularity, friability, and gland size—to create a single composite score of difficulty.…”

Section: Discussionmentioning

confidence: 99%

Novel Thyroidectomy Difficulty Scale Correlates with Operative Times

et al. 2014

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Introduction The aim of this study was to evaluate a new thyroidectomy difficulty scale (TDS) for its inter-rater agreement, correspondence with operative times, and correlation with complications. Methods We developed a four item, 20-point TDS. Following cases where two board-certified surgeons participated, each surgeon completed a TDS, blinded to the other’s responses. Paired sets of TDS scores were compared. The relationship between operative time and TDS scores was analyzed with linear regression. Multiple regression evaluated the association of TDS scores and other clinical data with operative times. Results A total of 119 patients were scored using TDS. In this cohort, 22.7% suffered from hyperthyroidism, 37.8% experienced compressive symptoms, and 58.8% had cancer. The median total TDS score was 8, and both surgeons’ total scores exhibited a high degree of correlation. 87.4% of both raters’ total scores were within one point of each other. Patients with hyperthyroidism received higher median scores compared to euthyroid patients (10 vs. 8, p<0.01). Similarly, patients who suffered a complication had higher scores compared to those patients without complications (10 vs. 8, p= 0.04). TDS scores demonstrated a linear relationship with operative times (R2 = 0.36, p<0.01, Figure 1). Cases with a score of 14 or greater took 41.0% longer compared to cases with scores of five or less (p<0.01). In multiple regression analysis, TDS scores independently predicted operative time (p<0.01). Conclusion The TDS is an accurate tool, and scores correlate with more difficult thyroidectomies as measured by complications and operative times.

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“…Among this number, only 20 (0.67%) were described as presenting with acute airway problems requiring emergency intervention, attributed to either severe luminal compression, intrathyroidal haemorrhage or upper respiratory infection. In a retrospective review of 813 cases of total thyroidectomy in India by Agarwal et al ,7 data analysis included a comparison between malignant and benign goitres with regard to respiratory distress. They noted a significantly higher rate of respiratory distress in malignant goitres among those weighing ≤400 g (5.3% vs 1.9%, p=0.013), and a slight but insignificantly increased rate among those over 400 g (40% vs 20%, p=0.15).…”

Section: Discussionmentioning

confidence: 99%

Acute respiratory failure in a rapidly enlarging benign cervical goitre

2013

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Benign goitres have the potential to reach massive sizes if neglected, but most have a protracted course that may or may not present with compressive symptoms. We report the case of a 57-year-old man who presented with a rapidly enlarging nodular goitre resulting in acute respiratory failure. Endotracheal intubation and emergency total thyroidectomy were performed, revealing massive thyroid nodules with minimal intrathoracic extension and tracheal erosion. Despite a course and clinical findings suggestive of malignant disease, histopathology was consistent with a benign multinodular goitre. Several cases of benign goitres necessitating endotracheal intubation have been reported. Airway compromise was attributed to a significant intrathoracic component, or inciting events such as thyroid haemorrhage, pregnancy, radioiodine uptake or major surgery. Obstructive symptoms may not correlate well with objective measures of upper airway obstruction such as radiographs or flow volume loops.

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Clinicopathological Profile, Airway Management, and Outcome in Huge Multinodular Goiters: An Institutional Experience from an Endemic Goiter Region

Cited by 35 publications

References 22 publications

Predictors of Difficult Airway Management in Thyroid Surgery: A Five-Year Observational Single-Center Prospective Study

Predictors of Difficult Airway Management in Thyroid Surgery: A Five-Year Observational Single-Center Prospective Study

Novel Thyroidectomy Difficulty Scale Correlates with Operative Times

Acute respiratory failure in a rapidly enlarging benign cervical goitre

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