Cervical Goiter – History

  • The history of goitrous growth and associated symptoms is critical for determining surgical candidacy:
    • This history should be obtained not only from the patient but also from his or her family
  • Regional symptoms should be addressed relating to:
    • Respiration
    • Phonation
    • Swallowing
    • Presence of globus (lump sensation)
  • As Pemberton emphasized in 1921:
    • Symptoms associated with goiter may be positionally induced
    • Positions that may provoke goiter regional symptomatology include being:
      • Supine
      • Arms raised (as when reaching for an upper cabinet),
      • Extreme neck extension
      • Extreme neck flexion (as with reading a book in bed)
      • Turning the head to the extreme left or right
        • Patients thus need to be questioned about positional provocation of regional symptoms
  • In addition, the family needs to be questioned about nocturnal symptoms:
    • As symptoms may manifest initially in the setting of recumbency and upper airway relaxation during sleep
  • Symptoms may also be associated with exercise and increased oxygen demands
  • A history of preceding upper respiratory tract infection may produce dyspnea in a patient with long-standing tracheal obstruction secondary to goiter:
    • Through new laryngotracheal mucosal edema
  • Patients with cervical or substernal goiter may present with:
    • Cough
    • Dyspnea
    • Foreign-body sensation
    • Neck tightness
    • Change in collar size
    • Wheezing:
      • Some patients may come to the head and neck surgeon with a misdiagnosis of asthma or chronic obstructive pulmonary disease (COPD)
  • Patients with large cervical and substernal goiter:
    • Approximately 25% of patients were asymptomatic
  • Symptoms of hypothyroidism and hyperthyroidism should be reviewed:
    • Hyperthyroidism may slowly evolve in patients with multinodular goiter or may develop acutely in response to significant iodine load such as with CT scan contrast (Jod-Basedow phenomenon) or with the introduction of iodized salt in endemic goiter regions
  • A history of migration from an area of endemic goiter should be obtained, as well as a history of exposure to known goitrogens, notably iodine and lithium
  • A family history of thyroid disease should be obtained

#Arrangoiz #ThyroidSurgeon #ThyroidExpert #HeadandNeckSurgeon #CancerSurgeon #MultinodularGoiter #Goiter #SubsternalGoiter #CervicalGoiter #CASO #CenterforAdvancedSurgicalOncolgy

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s