title: The surgical management of goiter: Part II. Surgical treatment and results.
abstract: OBJECTIVE
  Surgery for goiter embodies a unique challenge. Our objective is to provide a comprehensive analysis of cervical and substernal goiter data in two paired articles. This second article focuses on surgical management. The following null hypotheses regarding goiter excision have been tested: 1) there are no goiter-associated risk factors for difficult intubation; 2) there are no predictive risk factors for recurrent laryngeal nerve injury (RLN) or postoperative hypocalcemia; 3) there is no difference in RLN injury with neural monitoring versus without.
  
  
  METHODS
  A retrospective review of 200 consecutive thyroidectomies meeting inclusion/exclusion criteria for cervical or substernal goiter.
  
  
  RESULTS
  Temporary RLN paralysis occurred in 1.8% of nerves at risk and was significantly lower with recurrent laryngeal nerve monitoring than without. Permanent hypoparathyroidism occurred in 3% overall. Bilateral cervical goiter emerged as a definitive risk factor for difficult intubation (P = .05, univariate), recurrent laryngeal nerve injury (P = .002), and postoperative hypocalcemia (P = .001). Female patients (P = .04) or patients with positive family history (P = .01) were more likely to need repeat surgery. There were no cases of tracheomalacia, and sternotomy was required in 1%.
  
  
  CONCLUSIONS
  In this series of patients with extensive goiter, primary and revision surgery were associated with low rate of complications. Surgical complications were associated with bilateral and large goiters suggesting increased caution in these patients.
authors.affiliation: Department of Otology and Laryngology and Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA. gwrandolph@partners.org
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Randolph
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Shin
authors.forename: Hermes C
authors.initials: HC
authors.lastname: Grillo
authors.forename: Doug
authors.initials: D
authors.lastname: Mathisen
authors.forename: Mark R
authors.initials: MR
authors.lastname: Katlic
authors.forename: Dipti
authors.initials: D
authors.lastname: Kamani
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006042:Goiter / Q000175:diagnosis / Q000601:surgery*; D006045:Goiter, Substernal / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D061226:Recurrent Laryngeal Nerve Injuries; D012086:Reoperation; D012307:Risk Factors; D013965:Thyroidectomy / Q000009:adverse effects; D014826:Vocal Cord Paralysis / Q000209:etiology; D055815:Young Adult