Endocrine Abstracts

Introduction: Multi Nodular Goitre(MNG) has a slow, progressive growth. An apparently asymptomatic MNG can already have caused retrosternal upper airway obstruction. Yet MNG can also cause compressive manifestations without retrosternal extension. Timing of surgery can be critical for patients with a large goitre. The evidence is poor to guide management of large MNG with absolute indications for surgery. The aim of this uni-centre study is to analyze patients with large MNG and their surgery results.

Methods: We retrospectively searched the surgical database of the Academic Medical Centre for patients who underwent a Thyroid operation, between September 2009 and September 2011, because of large MNG. We analyzed patient characteristics, surgical aspects, and complications post-operative.

Results: 120 patients (age ≥ 16 years) underwent thyroid operation during Sept. 2009 to Sept. 2011.

Forty-five (38%) had MNG with a preoperative contents of ≥80cc or post-operative specimen weight of ≥80 gram. Patients were 80% female and 20% men, mean age 52 years (range 16–81 years). Duration of the MNG was between 4 months to 30 years. All patients had complaints of their MNG, 24 (53%) experienced dyspnoea. Sixteen (36%) of the patients had retrosternal MNG. Twenty-one (47%) patients had tracheal deviation and obstruction. Seven patients underwent awake fiberoptic intubation. In one case tracheostomy was necessary. Complications occurred in 13(29%) of the MNG group, compared to 10(15%) in the smaller thyroid group. Mortality was 4% (2/45). One patient had an anaplastic carcinoma (MNG 150 cc) and one patient (MNG 200 cc) had an inhospital cardiac arrest 15 days postoperatively. In the smaller thyroid group 1 patient, with an Amiodarone-induced Thyrotoxicosis, died after an inhospital cardiac arrest.

Conclusion: Resection of large goiters is associated with a higher complication rate. Therefore we conclude that earlier referral to a thyroid surgeon might influence the operative results.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector