open access

Vol 64, No 3 (2013)
Original papers
Published online: 2013-07-01
Submitted: 2013-07-31
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Acute respiratory failure in goitre patients qualified for operative treatment

Grzegorz Buła, Michał Paliga, Henryk Koziołek, Ryszard Mucha, Jacek Gawrychowski
Endokrynologia Polska 2013;64(3):215-219.

open access

Vol 64, No 3 (2013)
Original papers
Published online: 2013-07-01
Submitted: 2013-07-31

Abstract


Introduction: To present a clinical picture and management of goitre patients with acute respiratory failure.
Material and methods: A total of 7,356 patients were operated on between 2000 and 2011 for various goitres, including 1,214 (16.5%) retrosternal or mediastinal types. Eight (0.1%) patients (six women and two men aged 61–84, mean 76.9 years) presented with acute respiratory failure on admission. Seven patients were intubated on admission, and one showed severe dyspnoea at rest accompanied by symptoms of peripheral cyanosis.
Results: Giant retrosternal goitres were found in the eight operated patients. In two cases, the goitre was recurrent in character, and another two patients had previously suffered from hyperthyroidism (one treated pharmacologically, and one using J131). X-ray examination revealed tracheostenosis in all patients. No disorders in thyroid function was observed. Preoperative unilateral paralysis of laryngeal recurrent nerve was found in three patients. The operations were considered as most urgent. Four goitres were neoplastic: two were anaplastic carcinoma, one was follicular cell carcinoma and one was squamous cell carcinoma. These patients received partial resection to enable reduction of the goitre mass. In three patients, tracheostomy was necessary. On the other hand, four patients with non-malignant goitres underwent complete resection (one patient), nearly complete resection (two), and complete resection of one lobe and partial resection of the other (one). Three patients required mechanical ventilation postoperatively. Two of them, referred to the Intensive Therapy Unit, died from acute circulatory failure on day 6 and day 10 postoperatively. The rest were discharged in good general condition.
Conclusions:
1. Acute respiratory failure caused by a giant goitre is a life-threatening condition that almost always requires an emergency intubation.
2. Due to a high risk of complications and high mortality, patients with acute respiratory failure caused by giant goitres should be operated in hospitals that are very experienced not only in thyroid but also in mediastinal surgery. (Endokrynol Pol 2013; 64 (3): 215–219)

Abstract


Introduction: To present a clinical picture and management of goitre patients with acute respiratory failure.
Material and methods: A total of 7,356 patients were operated on between 2000 and 2011 for various goitres, including 1,214 (16.5%) retrosternal or mediastinal types. Eight (0.1%) patients (six women and two men aged 61–84, mean 76.9 years) presented with acute respiratory failure on admission. Seven patients were intubated on admission, and one showed severe dyspnoea at rest accompanied by symptoms of peripheral cyanosis.
Results: Giant retrosternal goitres were found in the eight operated patients. In two cases, the goitre was recurrent in character, and another two patients had previously suffered from hyperthyroidism (one treated pharmacologically, and one using J131). X-ray examination revealed tracheostenosis in all patients. No disorders in thyroid function was observed. Preoperative unilateral paralysis of laryngeal recurrent nerve was found in three patients. The operations were considered as most urgent. Four goitres were neoplastic: two were anaplastic carcinoma, one was follicular cell carcinoma and one was squamous cell carcinoma. These patients received partial resection to enable reduction of the goitre mass. In three patients, tracheostomy was necessary. On the other hand, four patients with non-malignant goitres underwent complete resection (one patient), nearly complete resection (two), and complete resection of one lobe and partial resection of the other (one). Three patients required mechanical ventilation postoperatively. Two of them, referred to the Intensive Therapy Unit, died from acute circulatory failure on day 6 and day 10 postoperatively. The rest were discharged in good general condition.
Conclusions:
1. Acute respiratory failure caused by a giant goitre is a life-threatening condition that almost always requires an emergency intubation.
2. Due to a high risk of complications and high mortality, patients with acute respiratory failure caused by giant goitres should be operated in hospitals that are very experienced not only in thyroid but also in mediastinal surgery. (Endokrynol Pol 2013; 64 (3): 215–219)
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Keywords

goitre; acute respiratory failure; thyroid carcinoma

About this article
Title

Acute respiratory failure in goitre patients qualified for operative treatment

Journal

Endokrynologia Polska

Issue

Vol 64, No 3 (2013)

Pages

215-219

Published online

2013-07-01

Bibliographic record

Endokrynologia Polska 2013;64(3):215-219.

Keywords

goitre
acute respiratory failure
thyroid carcinoma

Authors

Grzegorz Buła
Michał Paliga
Henryk Koziołek
Ryszard Mucha
Jacek Gawrychowski

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