The Impact of Esophageal Compression on Goiter Symptoms before and after Thyroid Surgery

Abstract

Introduction: Benign nodular goiter may be associated with swallowing difficulties, but insight into the associated pathophysiology is limited. The aim of this study was to investigate the effect of surgery on the degree of esophageal compression, and its correlation to swallowing difficulties. Methods: Esophageal compression and deviation were evaluated blindly on magnetic resonance imaging (MRI) of the neck, prior to and 6 months after thyroid surgery for symptomatic benign goiter. Goiter symptoms and swallowing difficulties were measured by the Goiter Symptom Scale of the Thyroid-Specific Patient-Reported Outcome (ThyPRO) questionnaire. Cohen’s d was used for evaluating effect sizes (ES). Results: Sixty-four patients completed the study. Before surgery, median goiter volume was 57 (range 14–642) mL. The smallest cross-sectional area of the esophagus (SCAE) increased from a median of 95 (47–147) to 137 (72–286) mm² (ES = 1.31, p < 0.001). Median esophagus width increased from 15 (range 10–21) to 17 (range 12–24) mm (ES = 0.94, p < 0.001) after surgery, while no statistically significant change was observed for the sagittal dimension (anterior-to-posterior), thus reflecting an increasingly ellipsoid esophageal shape. Median esophageal deviation decreased moderately after surgery from 4 (0–23) to 3 (0–10) mm (ES = 0.54, p = 0.005). The goiter symptom score improved considerably from (mean ± SD) 40 ± 21 to 10 ± 10 points (ES = 1.5, p < 0.001) after surgery, and the improvements were associated with improvements in SCAE (p = 0.03). Conclusions: In patients with goiter, thyroidectomy leads to substantial improvements in esophageal anatomy, as assessed by MRI, and this correlates with improved swallowing symptoms. This information is valuable in qualifying the dialogue with goiter patients, before deciding on the mode of therapy. Clinicaltrials.gov (NCT03072654).

The Impact of Goiter and Thyroid Surgery on Goiter Related Esophageal Dysfunction. A Systematic Review

“…Most of the included studies (Tables 2 , 3 ) were small, with 60 or fewer individuals in 14 of the 27 studies. Only one study applied randomization ( 15 ) and three studies used some blinding of participants, personnel or the evaluated outcomes ( 25 , 30 , 31 ). There were five observational studies, 17 studies investigating the impact of thyroidectomy, and five retrospective studies with two studies investigating thyroidectomy (Tables 2 , 3 ).…”

“…Affection of the esophagus was a common finding among patients with goiter (Table 2 ). Four studies evaluated, by chest X-ray, CT, or MRI, the prevalence of esophageal compression and/or deviation in patients undergoing thyroidectomy ( 8 , 16 , 24 , 25 ). A study of 198 patients found esophageal deviation in 14% of individuals, and esophageal compression in even fewer (8%) ( 16 ).…”

“…A more recent study ( 25 ), with well-defined definitions of both esophageal deviation and compression, evaluated 65 well-characterized goiter patients undergoing neck MRI before and 6 months after thyroidectomy. In that study, the median esophageal deviation decreased significantly from 4 mm (range: 0–23 mm) to 3 mm (range: 0–10 mm).…”

“…In that study, the median esophageal deviation decreased significantly from 4 mm (range: 0–23 mm) to 3 mm (range: 0–10 mm). More importantly, the median smallest cross-sectional area of the esophagus (SCAE) increased from 95 mm 2 (range: 47–147 mm 2 ) at baseline to 137 mm 2 (range: 72–286 mm 2 ) after surgery, corresponding to a median increase of 34% (range, −17 to 253%) in SCAE ( 25 ). The anterior-posterior depth of the esophagus did not change significantly following surgery, while the median-lateral width of the esophagus achieved a small but significant increase from a median of 15 mm (range: 10–21 mm) to 17 mm (range: 12–24) after surgery (Table 2 ).…”

“…The preoperative volumes of the thyroid and the SCAEs were significantly inversely correlated, with reduction in SCAE of 0.35 mm 2 for every 10% increase in goiter volume. In addition, the SCAE increased by 1% for every 10% increase in the weight of the removed thyroid tissue ( 25 ). This implies that patients with the initially largest goiters also experienced the most pronounced improvements in SCAE, following thyroid surgery.…”