Thyroidectomy Improves Tracheal Anatomy and Airflow in Patients with Nodular Goiter: A Prospective Cohort Study

Sørensen, Jesper Roed; Lauridsen, Jørgen T.; Døssing, Helle; Nguyen, Nina; Bonnema, Steen Joop; Godballe, Christian

doi:10.1159/000480348

Cited by 16 publications

(27 citation statements)

References 40 publications

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“…However, SCAE alone is not sufficient for explaining the developments in goiter symptoms, as the Goiter Symptom Score improved postoperatively by 30 points on average, while SCAE accounted for a reduction of only 0.6 points in goiter symptoms per 10% increase in SCAE. Compression of other neck structures, e.g., the trachea and spine, by goiter, might also contribute significantly to the various items included in goiter symptoms [7]. …”

Section: Discussionmentioning

confidence: 99%

“…Patients with symptomatic benign nodular goiter scheduled for thyroid surgery were included in a prospective cohort study [7, 19]. The inclusion period was from 1 November 2014 to 30 April 2016.…”

Section: Methodsmentioning

confidence: 99%

“…Nodular goiter was defined as an ultrasonically confirmed, enlarged thyroid gland, with a volume of > 18 mL for women and > 25 mL for men, and containing at least 1 nodule [7]. Serum levels of total thyroxine (T 4 ) and total tri-iodothyronine (T 3 ) had to be within the normal range of 67–134 and 1.35–2.33 nmol/L, respectively, but both subclinical hypo- and hyperthyroid patients (serum thyrotropin > or < the reference range, respectively) were eligible for inclusion.…”

Section: Methodsmentioning

confidence: 99%

“…This study is a substudy of a larger cohort study investigating changes in tracheal anatomy, swallowing physiology, and QoL after thyroid surgery [7, 16, 19, 26, 27]. In part, the data have been reanalyzed, for the purpose of addressing a completely different issue.…”

Section: Methodsmentioning

confidence: 99%

“…Nodular goiter can lead to a wide range of symptoms including swallowing discomfort and respiratory disturbances, which can have a negative impact on quality of life (QoL) [1, 5, 6]. A clear correlation between goiter volume, tracheal compression, and relief from this compression following thyroidectomy is seen in patients with benign goiter [7], but little is known concerning the impact of goiter on the esophagus. In studies using patient-reported outcomes, 47–83% of patients referred for thyroidectomy report swallowing difficulties [8-14].…”

Section: Introductionmentioning

confidence: 99%

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

Brinch¹,

Døssing²,

Nguyen³

et al. 2018

Eur Thyroid J

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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).

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Brinch¹,

Døssing²,

Nguyen³

et al. 2018

Eur Thyroid J

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Tracheomalacia in patients undergoing thyroid surgery—What is the true estimate: A systematic review and meta‐analysis

Ghaloo,

Afzal,

Abbas

et al. 2024

World j. otorhinolaryngol.-head neck surg.

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ObjectivesTracheomalacia is defined as the weakening of the tracheal rings secondary to long‐standing compression or inherent structural weakness, leading to stridor and airway compromise. The common etiological factor of tracheomalacia includes compression of the tracheal framework due to a large multinodular goiter. There are various management techniques described in the literature to manage a patient with tracheomalacia including tracheostomy, tracheal stenting, and tracheopexy. However, the evidence of tracheomalacia in the literature is conflicting. Therefore, a systematic review was conducted to estimate the incidence of tracheomalacia after thyroidectomy.MethodsThe systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A literature search was performed on PubMed, Web of Science, Cochrane library, and Elton B. Stephens Co. cumulative index to nursing and allied health literature plus to determine the incidence of tracheomalacia among patients undergoing thyroidectomy up till October 2021. The eligibility was assessed by two independent authors. A quality assessment of individual studies was performed using the National Institute of Health quality assessment tool. Outcomes were double data extracted and were analyzed using OpenMeta.ResultsThe online search retrieved 214 papers, out of which 17 studies were included that fulfilled the eligibility criteria. The number of patients included in the systematic review who underwent thyroidectomy was 1108. The mean age was 55.8 ± 7.7 years, ranging from 48 to 75 years. Tracheomalacia was reported in 146 patients (1.4%). Sternotomy was performed in 102 patients to approach the goiters with retrosternal extension. The most common intervention to manage tracheomalacia was tracheostomy or prolonged intubation.ConclusionsTracheomalacia is a rare complication. In cases where tracheomalacia is encountered, common methods of management include tracheostomy or prolonged endotracheal intubation. Prospective, long‐term studies are required to accurately assess its true incidence and associated factors.

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Quality of Life in Patients with Benign Non‐Toxic Goiter After Surgical Intervention: A Systematic Review and Meta‐Analysis

et al. 2022

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Background Prior studies evaluating health-related quality of life (HR-QoL) outcomes in patients undergoing surgery for benign non-toxic goiter have used different instruments and time points, leading to conflicting results. We sought to systematically review the differences in HR-QoL among patients with BNTG at baseline and 6 months after surgery, using exclusively the ThyPRO questionnaire. Methods A systematic search was performed using PubMed, Embase, Web of Science, Cochrane Central, CINAHL, and PsycINFO for papers reporting the assessment of HR-QoL utilizing ThyPRO. Data were meta-analyzed using a random-effects model, and pooled estimates were calculated using weighted mean differences (WMD) between baseline and 6 months after surgery. We assessed the quality and risk of bias of the studies using the Robins-I tool and previously published minimally important change (MIC) values to assess clinical significance. Results Six papers met the predefined inclusion criteria, describing a total of 496 patients. Meta-analysis demonstrated improved QoL in all thirteen domains of ThyPRO six months post-surgical intervention compared to baseline. Specifically, the largest improvement in QoL was seen in the domains of overall QoL, WMD -25.84 (95% CI -29.70, -21.98, p \ 0.001, I 2 = 23%), goiter symptoms, 23.96 (95% CI -30.29, -17.64, p \ 0.001, I 2 = 91%), and tiredness, -16.20 (95% , p \ 0.001, I 2 = 3%). The differences in scores 9 of 13 domains were clinically significant based on MIC. Conclusions Disease-specific HR-QoL improved in all ThyPRO domains after surgery in patients with BNTG. Future studies of QoL in thyroid surgery patients will benefit from a standard questionnaire and improved reporting of covariates including complications to ensure comparability across studies.

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Thyroidectomy Improves Tracheal Anatomy and Airflow in Patients with Nodular Goiter: A Prospective Cohort Study

Cited by 16 publications

References 40 publications

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

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

Tracheomalacia in patients undergoing thyroid surgery—What is the true estimate: A systematic review and meta‐analysis

Quality of Life in Patients with Benign Non‐Toxic Goiter After Surgical Intervention: A Systematic Review and Meta‐Analysis

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