Clinicopathological profile, airway management, and postoperative complications in huge goiters: a retrospective analysis of 33 cases

Year 2025, Volume: 50 Issue: 1, 115 - 124, 31.03.2025

Çağlar Eker , Arda Er , Malik Özen , Elvan Onan , Muhammed Dağkıran , Özgür Sürmelioğlu , Süleyman Özdemir

https://doi.org/10.17826/cumj.1560253

Abstract

Purpose: The aim of this study was to identify the clinical and pathological features of patients with huge goiters and to investigate the relationship between tumor size, retrosternal extension, and the incidence of postoperative complications.
Materials and Methods: All patients with huge goiters in the 5 years from 2018 to 2023 were reviewed in retrospect. The patients' clinicopathological and demographic details were recorded. Data from computed tomography scans were used to select the study patients. The study covered patients whose thyroid gland size was greater than 10 cm.
Results: The study comprised 33 patients who met the inclusion criteria. Dyspnea was the most frequent symptom of compression (75.7%). Tracheal compression was observed in 15 cases (45.4%). Nineteen patients (57.5%) had retrosternal extension. Two patients experienced permanent recurrent laryngeal nerve paralysis postoperatively, while eleven patients exhibited transient hypocalcemia. No significant differences were found between male and female patients regarding clinicopathological characteristics and complications. Furthermore, there was no evidence indicating that retrosternal extension or increased goiter size elevated the risk of complications.
Conclusion: Surgery remains the most effective way to quickly relieve compression symptoms in patients with huge goiters. Our experience indicates that thyroidectomy via a cervical incision can be safely conducted in nearly all patients with huge goiters, regardless of the presence of retrosternal extension, without elevating the risk of complications.

Keywords

Huge goiter, compression symptoms, retrosternal extension, thyroid surgery

Dev guatrların klinik ve patolojik profili, hava yolu yönetimi ve postoperatif komplikasyonları: 33 olgunun retrospektif analizi

Abstract

Amaç: Bu çalışmada, büyük guatrlı hastaların klinik ve patolojik özelliklerini belirlemeyi ve tümör boyutu ve retrosternal yayılım ile postoperatif komplikasyon sıklığı arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntem: 2018'den 2023'e kadar olan beş yılda büyük guatrı olan tüm hastalar geriye dönük olarak incelendi. Hastaların klinikopatolojik ve demografik bilgileri kaydedildi. Çalışma katılımcılarını seçmek için başvurudaki bilgisayarlı tomografi taraması bulguları kullanıldı. Çalışmaya tiroid bezi büyüklüğü 10 cm'den büyük olan hastalar dahil edildi.
Bulgular: Çalışmaya kriterleri karşılayan 33 hasta dahil edildi. Dispne en sık kompresyon semptomu (%75,7) idi. On beş olguda (%45,4) trakeal bası gözlendi. On dokuz hastada (%57,5) retrosternal yayılım saptandı. İki hastada ameliyat sonrası kalıcı rekürren laringeal sinir felci yaşanırken, on bir hastada geçici hipokalsemi görüldü. Erkek ve kadın hastalar arasında klinikopatolojik özellikler ve komplikasyonlar açısından anlamlı bir fark bulunmadı. Ayrıca, retrosternal uzanımın veya guatr boyutunun artmasının komplikasyon riskini artırdığına dair bir kanıt yoktu.
Sonuç: Cerrahi, büyük guatrı olan hastalarda kompresyon semptomlarını hızla gidermenin en etkili yolu olmaya devam etmektedir. Deneyimlerimiz, retrosternal uzanım olup olmadığına bakılmaksızın, büyük guatrlı hastaların hemen hemen hepsinde servikal insizyon yoluyla tiroidektominin komplikasyon riskini artırmadan güvenli bir şekilde gerçekleştirilebileceğini göstermektedir.

Keywords

Dev guatr, bası semptomları, retrosternal uzanım, tiroid cerrahisi

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