Outcomes of Total Thyroidectomy in Large Goiters With Retrosternal Extension and Tracheal Compression: A Multivariate Analysis.

introductionLarge retrosternal goiters often cause tracheal compression and deviation, leading to respiratory symptoms and complicating surgical treatment. Total thyroidectomy is the treatment of choice though it carries a risk of complications due to the altered anatomy and its proximity to vital structures. This study examines the outcomes of total thyroidectomy in patients with retrosternal goiters and assesses the impact of tracheal compression on clinical results.

methodsThis retrospective study included 32 patients treated with total thyroidectomy for retrosternal goiter between January 2018 and June 2024. Patient records were analyzed for clinical presentation, tracheal status, extent of retrosternal extension, intubation details, surgery performed, intraoperative findings, and postoperative complications. Tracheal compression and deviation were noted by preoperative imaging and flexible fiberoptic bronchoscopy. A correlation between difficult intubation and tracheal status was attempted. Complications such as hypocalcemia, recurrent laryngeal nerve palsy, and tracheomalacia were assessed alongside surgical variables.

resultsAmong the 32 patients, tracheal deviation was noted in 62.5% (n=20), and tracheal compression occurred in 43.8% (n=14). Complications included hypocalcemia in 43.8% (n=14) of cases, recurrent laryngeal nerve palsy in 6.25% (n=2), and tracheomalacia in 15.6% (n=5). Advanced airway management techniques such as flexible fiberoptic-assisted intubation were often required, particularly in cases with significant tracheal compression. Malignant goiters showed a higher incidence of tracheal deviation and postoperative complications but overall complication rates were comparable to benign cases.

conclusionLarge retrosternal goiters carry the risk of airway compromise and surgical complications, particularly in the presence of tracheal compression. Hence, preoperative assessment of tracheal involvement and tailored surgical approaches are essential to manage airway complications and improve postoperative outcomes. A multidisciplinary approach is recommended for the management of these cases to enhance patient outcomes.