Thyroidectomy for Massive Goiter Weighing more than 500 Grams. Technical Difficulties, Complications and Management. Review
Norman Oneil Machado
DOI: 10.4236/ss.2011.25060   PDF    HTML     7,437 Downloads   12,484 Views   Citations


Background: Multinodular goiter is a relatively common thyroid disorder with a marked female preponderance. Most of these goiters weigh less than 100 grams with those weighing more than 500 grams being exceptional. The massively expanding goiter due to the strategic anatomic location of thyroid gland, in addition to being cosmetically disfiguring can seriously compromise the patency of the trachea and oesophagus. Thyroidectomy for such goiters is a surgical challenge due to the possible association of tracheomalacia, retrosternal extension, skin involvement and the difficulty in intubation and dissection of the thyroid gland due to distorted and displaced anatomy. Material and methods: While presenting 2 patients who underwent thyroidectomy for glands weighing more than 500 grams, the literature is reviewed to analyze the technical difficulties and approach in such patients and the frequently encountered complications in them and their management. Results: A review of the literature revealed an additional 7 cases of patients who had undergone thyroidectomy for glands weighing more than 500 grams. Massively enlarged goiter was often associated with tracheomalacia, tracheal stenosis and retrosternal extension. Difficulty during surgery was most often encountered in establishing the airway and in exposure of the gland particularly when the skin was involved. The predominant postoperative complications were related to respiratory distress as a consequence of tracheomalacia and tracheal stenosis. Conclusion: In spite of the technical challenge related to the airway, and thyroidectomy, surgery continues to be the best option in experienced hands due to its distinct advantage of its immediate effect and complete resolution of compressive symptoms.

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N. Machado, "Thyroidectomy for Massive Goiter Weighing more than 500 Grams. Technical Difficulties, Complications and Management. Review," Surgical Science, Vol. 2 No. 5, 2011, pp. 278-284. doi: 10.4236/ss.2011.25060.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] T. A. Day, A. Chu and K.G. Hoang, “Multinodular Goi-ter,” Otolaryngologic Clinics of North American, Vol. 36, No. 1, 2003, pp. 35-54. doi:10.1016/S0030-6665(02)00157-3
[2] A. Berghout, W. M. Wersinga, H. A. Drexhage, N. J. Smits and J. L. Touber, “Comparison of Placebo with L—Thyroxine Alone or with Carbimazole for Treatment of Sporadic Non Toxic Goiter,” Lancet, Vol. 336, No. 8709,1990, pp. 193-197. doi:10.1016/0140-6736(90)91730-X
[3] K. R. Gardiner and C. F. Russell, “Thyroidectomy for Large Multinodular Colloid Goitre,” Journal of the Royal College of Surgeons of Edinburgh, Vol. 40, No. 6, 1995, pp. 367-370.
[4] K. D. Harjit and A. N. Hisham, “Large Fungating Thyroid Cancers. A Unique Surgical Challenge,” Asian Journal of Surgery, Vol. 28, No. 1, 2005, pp. 48-51. doi:10.1016/S1015-9584(09)60259-1
[5] A. M. Hodges, “Excision of a 1.9 Kg Goitre under Local Anaesthetic,” Tropical Doctor, Vol. 35, No. 1, 2005, p. 43. doi:10.1016/S1015-9584(09)60259-1
[6] K. Dere, E. Teksoz, H. Sen , M. E. Orhan, S. Ozkan and G. Dagli, “Anaesthesia in a Child with Massive Thyroid Enlargement,” Paediatric Anaesthesia, Vol. 18, No. 8, 2008, pp. 797-798. doi:10.1111/j.1460-9592.2008.02547.x
[7] M. Irfan, W. S. Jiham and H. Shahid, “Massive Goiter with Retrosternal Extension Encasing Trachea and Oe-sophagus,” Medical journal of Malaysia, Vol. 65. No. 1, 2010, pp. 85-86.
[8] J. A. Eloy, S. Omerhodzic, S. Yuan, E. M. Genden and A. S. Jacobson, “Extended Tracheal Stenosis Secondary to a Massive Substernal Goiter,” Thyroid, Vol. 17, No. 9, 2007, pp. 899-900. doi:10.1089/thy.2006.0291
[9] M. P. Holden, G. H. Wooler and M. I. Ionescu, “Massive Retrosternal Goitre Presenting with Hypertension,” Tho-rax, Vol. 27, No. 6, 1972, pp. 772-774. doi:10.1136/thx.27.6.772
[10] D. P. Martin-Hirsch and F. J. Lannigan, “The Manage-ment of Benign Thyroid Goiter Causing Tracheo-Oeso- phageal Embarrassment,” Journal of Laryngology & Otology, Vol. 109, No. 9, 1995,pp. 892-894. doi:10.1017/S0022215100131615
[11] H. Dralle, C. Sekulla, K. Lorenz, M. Brauckhoff and A. Machens, “German IONM Study Group. Intraoperative Monitoring of the Recurrent Laryngeal Nerve in Thyroid Surgery,” World Journal of Surgery, Vol. 32, No. 7, 2008, pp. 1358-1366. doi:10.1007/s00268-008-9483-2
[12] W. E. Green, W. H. Shepperd, H. M. Stevensen and W. Wilson, “Tracheal Collapse after Thyroidectomy,” British Journal of Surgery, Vol. 66, No. 8, 1979, pp. 554-557. doi:10.1007/s00268-008-9483-2
[13] N. T. Hamilton, C. Christophi, J. B. Swann and G. J. Robinson, “Endotracheal Intubation Following Thyroi-dectomy,” The Australian and New Zealand journal of surgery, Vol. 57, No. 5, 1987, pp. 295-298. doi:10.1111/j.1445-2197.1987.tb01360.x
[14] P. K. Sinha, P. K. Dubey and S. Singh, “Identifying Tra-cheomalacia,” British Journal of Anaesthesia, Vol. 84, No. 1, 2000, pp. 127-128.
[15] K. Moaz, R. A. Greatorex and J. G. Allen, “Identifying Tracheomalaciaan Alternative Approach,” British Journal of Anaesthesia, Vol. 85, No. 2, 2000, pp. 332-333.
[16] F. F. Palazzo, J. G. Allen and R. A. Greatorex, “Laryngeal Mask Airway and the Fibre-Optic Tracheal Inspection in Thyroid Surgery: A Method for Timely Identification of Tracheomalacia Requiring Tracheostomy,” Annals of The Royal College of Surgeons of England, Vol. 82, No. 2, 2000, pp. 141-142.
[17] B. Cady, “Management of Tracheal Obstruction from Thyroid Disease,” World Journal of Surgery, Vol. 6, No. 6, 1982, pp. 696-701. doi:10.1111/j.1445-2197.1987.tb01360.x
[18] E. M. ElBashier, A. B. Hassan Widtalla and M. ElMakki Ahmed, “Tracheostomy with Thyroidectomy: Indications, Management and Outcome: A Prospective Study,” Inter-national Journal of Surgery, Vol. 6, No. 2, 2008, pp. 147-150. doi:10.1016/j.ijsu.2008.01.010
[19] N. O. Machado, C. S. Grant, A. K. Sharma, H. A. AlSabi and S. V. Koliyadan, “Large Posterior Mediastinal Re-trosternal Goiter Managed by Transcervical and Lateral Thorocotomy Approach,” General Thoracic and Cardi-ovascular Surgery, Vol. 59, No. 7, 2011, pp. 507-511. doi:10.1007/s11748-010-0712-x
[20] Q. Liu, G. Djuricin and R. A. Prinz, “Total Thyroidectomy for Benign Thyroid Disease,” Surgery, Vol. 123, No. 1, 1998, pp. 2-7. doi:10.1016/S0039-6060(98)70221-1

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