Matthew Helm1, Philip Sobash2, Vidhur Sohini1 and Saju Joseph3,4*
1Texas Tech University Health Sciences Center, Lubbock, Texas, US
2Medical University of South Carolina, Charleston, South Carolina, USA
3Graduate Medical Education, Valley Health Systems, Las Vegas, Nevada, USA
4Department of Surgery, Roseman University School of Medicine, Las Vegas, Nevada, USA
*Corresponding Author: Saju Joseph, Associate Professor of Surgery, General Surgery Program Director, Roseman University School of Medicine, Las Vegas, Nevada, USA.
Received: January 19, 2018; Published: January 24, 2018
Citation: Saju Joseph., et al. “Management of Large Cervical Thyroid Goiters”. Acta Scientific Cancer Biology 2.1 (2018).
Thyroid goiter is a common condition caused by iodine deficiency or autoimmune diseases. Multiple factors can play into the prognosis of thyroid goiter such as location, responsiveness to medical management, and endocrine disturbances. Thyroidectomy and/or radioiodine ablation are the current standards for treatment of this condition. Diagnosis is based on history of foreign residence, physical exam, and clinical manifestations. Cervical and substernal thyroids represent the most common locations for the gland. Symptoms from thyroid goiters range from obstructive respiratory symptoms, dysphagia, nerve palsies, or thyroid malfunction. In very rare cases, goiters can present larger than 10 cm in length with major clinical manifestations. In numerous underdeveloped countries, extremely large goiters present a major challenge to manage due to lack of iodine in food products. Many of these patients present to the U.S. with severe dyspnea and other compressive symptoms that can complicate surgical intervention. Unfortunately, there is no current standard for the appropriate management of these larger masses, especially if malignancy is present. Most of the previous literature suggests subtotal thyroidectomy, but contains minimal follow-up in order to establish adequate treatment protocols. Over the last decade, our clinic has seen 12 patients presenting with true cervical thyroid masses larger than 10 cm, all with major obstructive symptoms. Due to the size of the masses, special considerations to airway management (including elective tracheostomy) is needed. We present a multidisciplinary approach and outcomes for this rare condition, with special considerations to the surgical techniques used.
Keywords: Cervical Thyroid; Goiters; Tracheostomy
Copyright: © 2018 Saju Joseph., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.