title: Emergency total thyroidectomy due to non traumatic disease. Experience of a surgical unit and literature review.
abstract: BACKGROUND
  Acute respiratory failure due to thyroid compression or invasion of the tracheal lumen is a surgical emergency requiring urgent management. The aim of this paper is to describe a series of six patients treated successfully in the emergency setting with total thyroidectomy due to ingravescent dyspnoea and asphyxia, as well as review related data reported in literature.
  
  
  METHODS
  During 2005-2010, of 919 patients treated by total thyroidectomy at our Academic Hospital, 6 (0.7%; 4 females and 2 men, mean age: 68.7 years, range 42-81 years) were treated in emergency. All the emergency operations were performed for life-threatening respiratory distress. The clinical picture at admission, clinical features, type of surgery, outcomes and complications are described. Mean duration of surgery was 146 minutes (range: 53-260).
  
  
  RESULTS
  In 3/6 (50%) a manubriotomy was necessary due to the extension of the mass into the upper mediastinum. In all cases total thyroidectomy was performed. In one case (16.7%) a parathyroid gland transplantation and in another one (16.7%) a tracheotomy was necessary due to a condition of tracheomalacia. Mean post-operative hospital stay was 6.5 days (range: 2-10 days). Histology revealed malignancy in 4/6 cases (66.7%), showing 3 primitive, and 1 secondary tumors. Morbidity consisted of 1 transient recurrent laryngeal palsy, 3 transient postoperative hypoparathyroidism, and 4 pleural effusions, treated by medical therapy in 3 and by drains in one. There was no mortality.
  
  
  CONCLUSIONS
  On the basis of our experience and of literature review, we strongly advocate elective surgery for patients with thyroid disease at the first signs of tracheal compression. When an acute airway distress appears, an emergency life-threatening total thyroidectomy is recommended in a high-volume centre.
authors.affiliation: Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari "Aldo Moro", Bari, Italy. angelagurrado@libero.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Testini
authors.forename: Francesco
authors.initials: F
authors.lastname: Logoluso
authors.forename: Germana
authors.initials: G
authors.lastname: Lissidini
authors.forename: Angela
authors.initials: A
authors.lastname: Gurrado
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Campobasso
authors.forename: Rocco
authors.initials: R
authors.lastname: Cortese
authors.forename: Giuseppe Massimiliano
authors.initials: GM
authors.lastname: De Luca
authors.forename: Ilaria Fabiola
authors.initials: IF
authors.lastname: Franco
authors.forename: Alessandro
authors.initials: A
authors.lastname: De Luca
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Piccinni