“Doctor, My Thyroid Is Choking Me” Comment on “Positional Dyspneaand Tracheal Compression as Indications for Goiter Resection”

Schneider D, Chen H. — Sun, 01 Jul 2012 00:00:00 GMT

Using a structured algorithm to evaluate respiratory symptoms in patients presenting for surgical treatment of thyroid disease, Stang and colleagues demonstrate that thyroidectomy ameliorates positional dyspnea and sleep apnea. Analysis of 197 patients with tracheal compression and/or positional dyspnea revealed that positional dyspnea improved in direct correlation to the resected gland weight. Those patients with obstructive sleep apnea experienced subjective improvement in snoring or dyspnea, but only a small number (3 patients) underwent postoperative polysomnography. Stang et al also observed a significant increase in the proportion of patients whose positional dyspnea improved when tracheal compression reached a threshold of at least 35%.

Positional Dyspnea and Tracheal Compression as Indications for Goiter Resection PD and TC as Indications for Goiter Resection

Stang MT, Armstrong MJ, Ogilvie JB, et al. — Sun, 01 Jul 2012 00:00:00 GMT

Hypotheses

Goiter is a surgically reversible cause of positional dyspnea (PD). Substernal tracheal compression (TC) predicts PD relief after thyroidectomy (Tx).

Design

Retrospective analysis of a prospective structured management algorithm.

Setting

Endocrine surgery academic center.

Methods

Before Tx, 1081 patients were queried about PD. Those patients with substernal goiter underwent computed tomography, and their degree of TC was estimated as greatest percent reduction of transverse tracheal diameter. For 197 patients with PD, TC, or both, surgical outcomes were examined with a mean follow-up of 12.6 months. After Tx, patients who carried the diagnosis of obstructive sleep apnea were referred for repeat sleep study evaluation.

Results

Positional dyspnea was reported by 188 of 1081 patients, and after Tx the PD improved or resolved in 82.4%. In the 151 patients with substernal goiter, TC was present on imaging in 97.2%; the mean (range) TC was 34% (5%-90%). Patients with TC had a high likelihood of PD (93.5%). After substernal goiter resection, PD improved in stepwise association with total resected thyroid gland weight. Improvement in PD was strongly predicted by both gland weight of 100 g or more (P < .001) and by TC of 35% or more (P < .01). After Tx, 59 of 77 snorers (76.6%) reported improvement in snoring, 77.1% of patients with obstructive sleep apnea reported improved PD, and 2 of 3 retested patients with obstructive sleep apnea demonstrated objective improvement in sleep study apnea-hypopnea index.

Conclusions

Resection of bulky goiter frequently improves PD, which in substernal goiter is highly associated with TC. Either PD or TC of 35% or more prompt Tx. Goiter should be considered when obstructive sleep apnea is diagnosed.

JAMA Surgery: Airway Disorders Topic Collection

“Doctor, My Thyroid Is Choking Me” Comment on “Positional Dyspneaand Tracheal Compression as Indications for Goiter Resection”

Positional Dyspnea and Tracheal Compression as Indications for Goiter Resection PD and TC as Indications for Goiter Resection