title: [Toxic intrathoracic goiter. Clinical profile and surgical morbidity in an endocrine surgery unit].
abstract: BACKGROUND
  The development of postsurgical complications is exacerbated when several risk factors coincide in the same patient.
  
  
  OBJECTIVE
  To analyze the results of surgery for toxic intrathoracic goiter in terms of (a) the need for sternotomy; (b) morbidity and mortality; and (c) remission of compressive symptoms.
  
  
  METHODS
  A review (1980-2002) was carried out of 43 cases of toxic intrathoracic multinodular goiter according to Eschapase's definition (3 cm below the sternal manubrium) occurring in patients without previous thyroid surgery who underwent total thyroidectomy. There were 2 control groups: I (non-toxic intrathoracic goiter, without recurrence and not requiring total thyroidectomy) and II (non-intrathoracic, non-toxic goiter without recurrence, requiring total thyroidectomy). The following variables were analyzed: sociopersonal, clinical and surgical characteristics, morbidity, mortality, and outcome.
  
  
  RESULTS
  Compared with the control groups, the patient group had longer disease duration and was older. In 6 patients (14%) 1 was difficulty in intubation, and 2 patients required fiberoptic intubation. All goiters could be extirpated through the cervical route. The morbidity rate was 37% (n=16). Notably, 4 were recurrent lesions (9%), 1 of which was definitive, and 14 were hyperparathyroidism (33%), one of which was definitive. The only difference between the control groups and the patient group was a greater incidence of transitory hypoparathyroidism in the patient group than in control group II (33% versus 15%; p=0.0103). Surgical outcomes were excellent in terms of symptom remission.
  
  
  CONCLUSIONS
  In any unit with ample experience of endocrine surgery, total thyroidectomy in toxic intrathoracic goiter can be carried out with a low risk of postsurgical complications, a low incidence of sternotomies and complete symptom remission. In intrathoracic goiter surgery, the presence of associated hyperthyroidism does not increase postoperative morbidity.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo I, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. arzrios@teleline.es
authors.forename: Antonio
authors.initials: A
authors.lastname: Ríos
authors.forename: José M
authors.initials: JM
authors.lastname: Rodríguez
authors.forename: Beatriz
authors.initials: B
authors.lastname: Febrero
authors.forename: María D
authors.initials: MD
authors.lastname: Balsalobre
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Tébar
authors.forename: Pascual
authors.initials: P
authors.lastname: Parrilla
mesh_terms: D005260:Female; D006045:Goiter, Substernal / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies