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

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