Results of surgical treatment in multinodular goiter with an intrathoracic component.
OBJECTIVE
(1) To determine the clinical profile of intrathoracic multinodular goiter (IMG); (2) to evaluate the results of surgery, and (3) to analyze the incidence of malignancy and its evolution.


METHODS
Two hundred and forty-seven operated cases of IMG were reviewed. These cases of IMG had all been diagnosed according to Eschapse's definition (>3cm below the sternal manubrium). The morbidity and postoperative evolution were analyzed. A comparative study was carried out on a group of 425 cases of nonintrathoracic goiter. We applied the chi(2) test, Student's t-test, and a logistical regression analysis.


RESULTS
Intrathoracic MG occurs in patients over 60 years of age, with goiter which has a long evolution time (>12 years), and more than 60% are symptomatic. Oral tracheal intubation was difficult in 10% (n = 24) of the cases, and 7 required the use of a fibrobronchoscope. In 8 cases (3%) a thoracic approach was necessary. Morbidity occurred in 24% (n = 59), most notably 29 recurring lesions (12%), of which 2 were definitive (0.8%), and 31 hypoparathyroidisms (13%), of which 1 was definitive (0.4%). No significant difference was found in the postsurgical morbidity between the intrathoracic MG and the nonintrathoracic cases. Regarding the remission of the symptoms, the results were excellent. In 14 cases (5.7%) thyroid carcinoma was related with, most of these being papillary microcarcinoma. In 10 of the 49 cases of partial surgery (20%) a relapse of the goiter was observed.


CONCLUSIONS
Intrathoracic MG is usually asymptomatic and it occurs in goiter with a long time of evolution. Surgery is a good therapeutic option given that the goiter can be removed via the neck, with low morbidity, a remission of the symptoms, malignancy is ruled out, and recurrence can be avoided if a total thyroidectomy is performed.
Departamento de Cirugía, Universidad de Murcia, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
Antonio
A
Ríos
José M
JM
Rodríguez
Pedro J
PJ
Galindo
Juan
J
Torres
Manuel
M
Canteras
María D
MD
Balsalobre
Pascual
P
Parrilla
D002291:Carcinoma, Papillary / Q000150:complications; D005260:Female; D006045:Goiter, Substernal / Q000601:surgery*; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology; D007442:Intubation, Intratracheal; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D013964:Thyroid Neoplasms / Q000150:complications; D013965:Thyroidectomy; D016896:Treatment Outcome