Benign nodular goitre presenting as acute airway obstruction.
BACKGROUND
Although rare in non-endemic areas, benign nodular goitre may cause acute airway obstruction and the clinical management of this condition remains a challenge.


METHODS
From 1996 to 2005, a total of 1115 patients underwent thyroid surgery at our institution and of these, 7 patients were identified to have a benign nodular goitre leading to acute airway obstruction. They were retrospectively reviewed with reference to the aetiology, presentation, perioperative management and postoperative outcome.


RESULTS
All seven patients were elderly women with a history of symptomatic goitre and concomitant medical problems. Five patients required emergency tracheal intubation, whereas two patients underwent urgent tracheostomy. Total thyroidectomy was successfully carried out for all patients and there was no hospital death. Perioperative complications included three patients with pneumonia, two with renal failure and one with perforated duodenal ulcer. Surgically related complications included transient recurrent nerve palsy in one patient and transient hypocalcaemia in four. After a median follow up of 22 months (range, 4-53 months), two patients died of cerebrovascular accident.


CONCLUSIONS
Prompt airway protection followed by total thyroidectomy within the same hospital admission should be recommended and can be associated with favourable outcome.
Abraham
Deepak
D
Department of Surgery, The University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong, China.
Singh
Nikhil
N
Lang
Brian
B
Chan
Wai-Fan
WF
Lo
Chung-Yau
CY
D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology* / Q000601:surgery; D005260:Female; D006044:Goiter, Nodular / Q000150:complications* / Q000601:surgery; D006801:Humans; D007442:Intubation, Intratracheal; D012189:Retrospective Studies; D013965:Thyroidectomy; D014139:Tracheostomy