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Original Article
January 1, 2005

Surgical Management of Multinodular Goiter With Compression Symptoms

Author Affiliations

Author Affiliations: Servicio de Cirug[[iacute]]a General y del Aparato Digestivo I (Drs R[[iacute]]os, Rodr[[iacute]]guez, Galindo, and Parrilla), Servicio de Bioestad[[iacute]]stica de la Universidad de Murcia (Dr Canteras), Servicio de Endocrinolog[[iacute]]a y Nutrici[[oacute]]n (Dr Tebar), Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.

Arch Surg. 2005;140(1):49-53. doi:10.1001/archsurg.140.1.49
Abstract

Hypothesis  Multinodular goiter (MG) with compression symptoms has a clinical profile different from that of goiter without these symptoms. The surgical treatment of MG with compression symptoms has a high rate of sternotomy and morbidity.

Design  Retrospective study conducted between 1970 and 1999.

Setting  Tertiary referral center.

Patients  One hundred fifty-seven patients with MG with compression symptoms were reviewed from 672 patients with MG undergoing surgery in our department. We used 515 patients with MG without compression symptoms as a control group.

Intervention  All 157 patients underwent programmed surgery for thyroidectomy.

Main Outcome Measures  General patient data, history and symptoms, exploration (both physical and with complementary techniques), data on the surgery and surgeon, and postsurgery morbidity and evolution. The χ2 test, the t test, and a logistic regression test were applied.

Results  Multinodular goiter with compression symptoms is characterized by its appearance in persons older than 55 years, a preoperative evolution of more than 10 years, and an intrathoracic component in more than 75% (P<.001). All the patients underwent surgery, with 6 (4%) requiring a sternotomy. Twenty-four percent had complications (n = 37), 3% of which corresponded to 4 cases of permanent recurrent laryngeal nerve injury. Eleven patients (7%) had an associated thyroid carcinoma, 9 of them corresponding to microcarcinomas. However, 5 were multifocal, and there was 1 anaplastic carcinoma, from which the patient died. All the papillary carcinomas are currently asymptomatic. The symptoms were remitted after surgery in all the cases except 1 dysphonia. Of the 32 patients receiving partial surgery, 9 (28%) had recurrence, of whom 6 underwent reoperation to complete the thyroidectomy.

Conclusions  Multinodular goiter with compression symptoms occurs in long-evolving goiters with an intrathoracic component. Surgery is the definitive treatment, as it excludes malignancy, involves low rates of permanent morbidity and mortality, and, if the technique is total thyroidectomy, avoids recurrences.

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