Abstract
BackgroundAcute respiratory failure due to thyroid compression or invasion of the tracheal lumen is a surgical emergency requiring urgent management. The aim of this paper is to describe a series of six patients treated successfully in the emergency setting with total thyroidectomy due to ingravescent dyspnoea and asphyxia, as well as review related data reported in literature.MethodsDuring 2005-2010, of 919 patients treated by total thyroidectomy at our Academic Hospital, 6 (0.7%; 4 females and 2 men, mean age: 68.7 years, range 42-81 years) were treated in emergency. All the emergency operations were performed for life-threatening respiratory distress. The clinical picture at admission, clinical features, type of surgery, outcomes and complications are described. Mean duration of surgery was 146 minutes (range: 53-260).ResultsIn 3/6 (50%) a manubriotomy was necessary due to the extension of the mass into the upper mediastinum. In all cases total thyroidectomy was performed. In one case (16.7%) a parathyroid gland transplantation and in another one (16.7%) a tracheotomy was necessary due to a condition of tracheomalacia. Mean post-operative hospital stay was 6.5 days (range: 2-10 days). Histology revealed malignancy in 4/6 cases (66.7%), showing 3 primitive, and 1 secondary tumors. Morbidity consisted of 1 transient recurrent laryngeal palsy, 3 transient postoperative hypoparathyroidism, and 4 pleural effusions, treated by medical therapy in 3 and by drains in one. There was no mortality.ConclusionOn the basis of our experience and of literature review, we strongly advocate elective surgery for patients with thyroid disease at the first signs of tracheal compression. When an acute airway distress appears, an emergency life-threatening total thyroidectomy is recommended in a high-volume centre.
Highlights
Acute respiratory failure due to thyroid compression or invasion of the tracheal lumen is a surgical emergency requiring urgent management
Bilateral recurrent laryngeal nerve infiltration by anaplastic cancer, lymphoma, metastasis can result in vocal cord palsy with worsening dyspnoea [13]
Hemorrhage in cysts and adenoma of thyroid gland is a common asymptomatic event [6]; On the contrary, massive hemorrhage, severe enough to result in acute airway distress is exceptional and more frequently secondary to neck trauma rather than a spontaneous complication of thyroid disease [14,15,16]
Summary
Acute respiratory failure due to thyroid compression or invasion of the tracheal lumen is a surgical emergency requiring urgent management. Total thyroidectomy is a routine elective operation, but exceptionally it has to be performed on an Laryngo-tracheal compression may be caused by giant or cervico-mediastinal goiter, acute intra-thyroidal hemorrhage, anaplastic carcinoma, lymphoma, and metastases from breast, lung, gastro-enteric and renal cancer [6,7,8,9,10,11,12]. Bilateral recurrent laryngeal nerve infiltration by anaplastic cancer, lymphoma, metastasis can result in vocal cord palsy with worsening dyspnoea [13]. Hemorrhage in cysts and adenoma of thyroid gland is a common asymptomatic event [6]; On the contrary, massive hemorrhage, severe enough to result in acute airway distress is exceptional and more frequently secondary to neck trauma rather than a spontaneous complication of thyroid disease [14,15,16].
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