The surgical management of goiter: Part II. Surgical treatment and results

Authors

  • Gregory W. Randolph MD,

    Corresponding author
    1. Department of Otology and Laryngology and Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.
    2. Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
    • Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114
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    • Department of Surgery, Division of Surgical Oncology, Endocrine Surgical Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.

  • Jennifer J. Shin MD,

    1. Department of Otology and Laryngology and Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.
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  • Hermes C. Grillo MD,

    1. Department of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
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    • Deceased.

  • Doug Mathisen MD,

    1. Department of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
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  • Mark R. Katlic MD,

    1. Division of Thoracic Surgery, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, U.S.A.
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  • Dipti Kamani MD,

    1. Department of Otology and Laryngology and Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.
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  • David Zurakowski PhD

    1. Department of Biostatistics, Children's Hospital Boston, Boston, Massachusetts, U.S.A.
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  • The authors have no financial disclosures for this article.

  • The authors declare no conflicts of interest.

Abstract

Objectives/Hypothesis:

Surgery for goiter embodies a unique challenge. Our objective is to provide a comprehensive analysis of cervical and substernal goiter data in two paired articles. This second article focuses on surgical management. The following null hypotheses regarding goiter excision have been tested: 1) there are no goiter-associated risk factors for difficult intubation; 2) there are no predictive risk factors for recurrent laryngeal nerve injury (RLN) or postoperative hypocalcemia; 3) there is no difference in RLN injury with neural monitoring versus without.

Study Design:

A retrospective review of 200 consecutive thyroidectomies meeting inclusion/exclusion criteria for cervical or substernal goiter.

Results:

Temporary RLN paralysis occurred in 1.8% of nerves at risk and was significantly lower with recurrent laryngeal nerve monitoring than without. Permanent hypoparathyroidism occurred in 3% overall. Bilateral cervical goiter emerged as a definitive risk factor for difficult intubation (P = .05, univariate), recurrent laryngeal nerve injury (P = .002), and postoperative hypocalcemia (P = .001). Female patients (P = .04) or patients with positive family history (P = .01) were more likely to need repeat surgery. There were no cases of tracheomalacia, and sternotomy was required in 1%.

Conclusions:

In this series of patients with extensive goiter, primary and revision surgery were associated with low rate of complications. Surgical complications were associated with bilateral and large goiters suggesting increased caution in these patients. Laryngoscope, 2011

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