Interventional bronchoscopy for treatment of tracheal obstruction secondary to benign or malignant thyroid disease.
OBJECTIVE
Surgery is the treatment of choice for symptomatic tracheal obstruction due to benign or malignant thyroid disease. In case of inoperability, or when surgery is refused, few therapeutic alternatives are available. Interventional bronchoscopic procedures have only been reported anecdotally. The objective of this study is to evaluate the results of interventional bronchoscopic procedures in the treatment of severe tracheal obstruction due to thyroid disease.


METHODS
Retrospective cohort analysis.


METHODS
University hospital, tertiary referral center.


METHODS
Thirty consecutive patients referred for bronchoscopic treatment of benign (n = 17) or malignant (n = 13) thyroid-related upper airway obstruction due to tracheomalacia, extrinsic compression, and/or tracheal ingrowth. Indications for bronchoscopic treatment were medical or surgical inoperability, prevention or treatment of tracheomalacia, and refusal of surgery. There were no procedure-related complications.


METHODS
Rigid bronchoscopy with dilatation, stenting and/or Nd-YAG laser treatment, and clinical follow-up.


RESULTS
Subjective improvement, pulmonary function tests, early and late complications, and survival. In the benign group, immediate (100% relief of dyspnea) and long-term (88% relief of dyspnea) results were excellent after airway stenting (21 stents used in 17 patients). There was one unrelated death 1 week after stenting in a 98-year-old patient. There were 6% and 30% short-term and long-term complications, respectively, that could be managed endoscopically. In the malignant group, Nd-YAG laser treatment (n = 3) and stenting (n = 13) yielded immediate and long-term success in 92% of patients. There were 15% short-term and 8% long-term complications. Median survival time was 540 days.


CONCLUSIONS
Interventional bronchoscopic procedures including Nd-YAG laser treatment and stenting are valuable alternatives to surgery in inoperable thyroid-induced tracheal obstruction, or when surgery is refused.
Noppen
Marc
M
Interventional Endoscopy Clinic and Respiratory Division, Academic Hospital AZ-VUB 101, Free University of Brussels, Laarbeeklaan V, 1000 Brussels, Belgium. marc.noppen@az.vub.ac.be
Poppe
Kris
K
D'Haese
Jan
J
Meysman
Marc
M
Velkeniers
Brigitte
B
Vincken
Walter
W
D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000379:methods*; D002404:Catheterization / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011336:Probability; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D016019:Survival Analysis; D013959:Thyroid Diseases / Q000150:complications / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000150:complications / Q000473:pathology; D014135:Tracheal Stenosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome