Surgical treatment for multinodular goitres in geriatric patients.
BACKGROUND
Although age is not a contraindication for thyroid surgery, few elderly patients undergo surgery due to the greater risk of morbidity. The aims of this study are to determine in patients aged >65 years: (1) whether the indications for surgery on multinodular goitre (MG) differ with respect to younger patients; (2) the surgical results; and (3) whether the postsurgery morbidity and mortality rates are higher.


METHODS
Eighty-one patients aged over 65 years who were receiving surgery for MG were analysed; 40 49%) presented with associated co-morbidities. Sixty percent had thyroid symptoms, either compressive and/or toxic. All underwent programmed surgery following stabilisation and strict control of their co-morbidities. As a control group we used 510 MG patients receiving surgery and aged between 30 and 65 years.


RESULTS
Compared with the control group the geriatric patients had a longer time of goitre evolution (P=0.032), greater presence of symptoms (P=0.001) and a higher percentage of intrathoracic component (P=0.001). Compressive symptoms were the major indication for surgery (P=0.001). Postoperative complications occurred in 40% of the patients, a higher rate than in the control group (28%; P=0.011), although a large percentage of those complications were transitory. Definitive complications included two recurrent laryngeal nerve injuries (2.5%). The preoperative symptoms remitted in all the patients, and only three were associated with a thyroid carcinoma, one of which was anaplastic.


CONCLUSIONS
MG operated on in elderly patients has a longer evolution and an intrathoracic component, and surgery is indicated restrictively. With close monitoring of the co-morbidities and a programmed operation the results with regard to morbidity and mortality are similar to those obtained at younger ages.
Ríos
Antonio
A
Department of General Surgery and Digestive Apparatus I, Virgen de la Arrixaca University Hospital, Murcia, Spain. ARZRIOS@teleline.es
Rodríguez
José Manuel
JM
Galindo
Pedro José
PJ
Canteras
Manuel
M
Parrilla
Pascual
P
D000368:Aged; D015897:Comorbidity; D005260:Female; D006044:Goiter, Nodular / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D006961:Hyperparathyroidism / Q000453:epidemiology; D006980:Hyperthyroidism / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods