Tracheal or esophageal compression due to benign thyroid disease.
ABSTRACT Tracheal or esophageal compression was present in 91 (33 percent) of 273 consecutive patients with benign goiter during a 7 year experience. The underlying disease was nodular colloid goiter in 66 percent, adenoma in 21 percent, thyroiditis in 9 percent and Graves' disease in 4 percent. The incidence of tracheoesophageal compression was higher in patients with thyroiditis (67 percent) than in those with colloid goiter (46 percent). Thirty of 91 patients were completely asymptomatic but had marked tracheal deviation on roentgenography. Two thirds presented with significant dyspnea, or dysphagia or both. A long history of goiter preceding the onset of symptoms and progressive worsening of compression symptoms after its onset were common in the latter group. Previous radiographs demonstrating significant tracheal deviation during a previous presymptomatic period were available in 11 of 36 dyspneic patients. Sudden tracheal occlusion developed in 3 percent and required emergency treatment. Tracheal compression occurred more often and when present was a more ominous symptom. Compression manifestations were more frequent in patients with multinodular goiter, were more likely to appear when the underlying disorder was thyroiditis affected the tracheal more often than the esophagus and were generally gradually progressive with time. A clinical spectrum ranging from a presymptomatic tracheal compression stage to one wherein progressive worsening of symptoms occurs is suggested. After symptoms of tracheal compression become clinically manifest, the occurrence of complete airway occlusion may be sudden and unpredictable. Early operation whenever roentgenographic evidence of tracheal deviation becomes manifest is recommended.
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ABSTRACT: Objective: Following radioiodine (RI) therapy for multinodular goiter (MNG), 4% to 5% of patients are reported to develop Graves' hyperthyroidism. To show a new protocol for the administration of RI in MNG and to illustrate an infrequent adverse event observed after the RI dose. Methods: A 70-year-old euthyroid woman with a tracheal compression and displacement. Baseline serum thyroid-stimulating hormone (TSH) was 1.1 mUI/mL, and RI uptake was 10% at 24 hours. The patient refused surgical treatment. We decided to employ a special protocol for increasing the thyroid uptake of 131I. Methyl mercaptoimidazol (MMI) was administered orally (30 mg/d) to increase TSH levels. Thyroid hormones were measured monthly. Three months after initiation of MMI treatment, TSH levels increased to 5.3 mUI/mL, and thyroid RI uptake increased to 57% at 24 hours with more uniform uptake. She received an RI dose of 30 mCI131I. Six weeks later, she was euthyroid. Six months later, a CT showed a decrease in the thyroid size, but she was overtly hyperthyroid (TSH <0.05 mUI/mL, T3 = 442 ng/dL, T4 = 4.8 μg/mL, and TSH receptor antibodies, TRAb >55% [NV <10%]). Conclusion: We present this case to describe an infrequent adverse complication of RI administration in patients with MNG. We also illustrate an alternative protocol for the administration of RI dose in such patients.The Endocrinologist 12/2009; 20(1):7-9. · 0.12 Impact Factor
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ABSTRACT: Compressive symptoms due to malignant thyroid disorders and retrosternal goiter have been shown to be associated with increased perioperative morbidity. However, little is known about the risk associated with the surgical management of patients presenting with cervical compressive symptoms secondary to benign thyroid disorders. A retrospective review of data of patients undergoing thyroid surgery in a tertiary referral center was performed. The outcomes of patients with compressive symptoms due to benign thyroid disorders were compared to those of patients without compressive symptoms. 886 patients operated upon between 2005 and 2012 were included for analysis. 284 cases with compressive symptoms (study group) were compared to 602 cases without compressive symptoms (control group). There was no difference in the duration of surgery among both groups (123 vs. 126 min, p = 0.75). There was no significant difference among both groups with regard to postoperative hypocalcemia (1.4 vs. 1.1 %), rate of recurrent laryngeal nerve palsy (6.3 vs. 7.2 %) and postoperative bleeding (2.1 vs. 3.1 %). Compressive symptoms resolved in a significant number of patients following surgery. There was no significant difference in postoperative outcome between patients with and without compressive symptoms. Therefore, cervical compression due to benign thyroid disorders is not associated with increased perioperative morbidity.Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 07/2014; · 1.46 Impact Factor