Rare presentation of an intrathoracic goiter

There are few encounters with massive thyromegaly and intrathoracic extension as a result of the general usage of iodized salt and bread, which was an early therapeutic intervention for thyroid disorders. However, cervical goiter enlargement over time may extend into the thoracic space, causing respiratory distress, dysphagia, and vascular compression. Hence, even though it may be asymptomatic, there is potential for sudden enlargement (secondary to hemorrhage), cystic degeneration, or malignant change that can be life threatening and may require surgery. Patients who underwent surgery with curative intent for intrathoracic goiter from January 1970 to July 2002 were included in this retrospective study at the thoracic surgical division of Taipei Veteran General Hospital in Taipei, Taiwan. Data were compared between patients ≥65 years of age (elderly group) and patients <65 years of age (younger group). Patient characteristics, hospital course, surgical mortality, morbidity, and survival were compared between patients in these two age groups. Total surgical treatment was given in 153 patients (men, 85; women, 68) with a mean age of 66.9 years (range, 41–86 years) who were enrolled in our study. A total of 95 (62.1%) patients were at least 65 years of age (mean age, 74.2 years) and 58 (37.9%) patients were younger than 65 years of age (mean age, 55 years; p < 0.001). Mean hospitalization was 9.5 days (range, 4–115 days), and the mean follow-up period was 4.5 years (range, 4 months–14 years). The elderly group had a significantly higher risk of respiratory syndromes (63.2% versus 34.5%, p < 0.001) and were predominantly men (63.2% versus 43.1%, p < 0.001). However, the elderly group had a significantly lower incidence of malignancy (0% versus 12.1%, p < 0.001). The pathology was generally found to be benign in elderly patients, but seven (12.1%) patients presented with carcinoma in the younger group. The mortality and complications were observed in 1.3% and 10.5% of the all patients. The results of this study suggest that curative surgery for intrathoracic goiter in elderly patients may result in high risks of acute airway compression compared with younger patients. Our data suggest that an age of 65 years or older should not be contraindicated for curative surgery in intrathoracic goiter patients. Surgical resection is recommended for all intrathoracic goiters due to high risks of acute airway compression and occult malignancy.