Goiter Workup

• In the workup of patients presenting with a goiter, the clinician most address the following three important issues:
  • The existence or the potential development of airway compression
  • The risk of malignancy
  • The presence of hyperthyroidism
• The presence of preoperative shortness of breath:
  • Correlates with goiter size:
    • But it is of limited value as a screening tool for tracheal abnormalities
• Dysphagia correlates with radiographic findings of esophageal deviation and compression:
  • In the absence of dysphagia:
    • Patients do not require further esophageal imaging
• Symptomatic assessment of voice:
  • Does not predict objective findings in patients with goiter and should not replace the laryngeal exam
• Flow volume loop studies most accurately document airway obstruction in the setting of significant airway compression:
  • However, they correlate poorly with goiter weight and upper airway symptoms:
    • I do not recommend flow volume loop studies as part of the routine work-up for patients with goiter
  • Thus, symptomatic flow volume loop and plain film assessment of goiter is insensitive, in distinction to axial CT scanning
  • The finding of tracheal compression on axial CT scanning correlates significantly with the presence of shortness of breath:
    • CT scan tracheal compression to be an appropriate surgical indication given its symptomatic respiratory correlate
• Work up of benign goiter:
  • History and physical examination:
    • Symptomatic
    • Massive goiter
    • Bilateral circumferential goiter
    • Suspect substernal goiter
    • Suspect cancer (vocal cord paralysis, lymphadenopathy)
• Thyroid function tests
• Chest radiograph if suspect cancer:
  • Chest radiograph showing airway deviation → axial CT or MRI

#Arrangoiz #ThyroidSurgeon #CancerSurgeon #ThyroidExpert #EndocrineSurgery #HeadandNeckSurgery #MultinodularGoiter #Goiter #SubsternalGoiter #MountSinaiMedicalCenter