Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Goiters that descend into the mediastinum can cause respiratory embarrassment, dysphagia, vascular compression, vocal cord paralysis, and sudden death. Although many such goiters remain clinically silent, their ability to produce sudden and unpredictable respiratory distress is well known. The condition was not considered uncommon in the first half of the twentieth century; some authors reported series of hundreds of thyroidectomies for intrathoracic goiter. Though seen less frequently today, the only effective treatment for mediastinal goiter is surgical removal. We report our experience with the management of 70 consecutive patients with substernal or intrathoracic goiters. The clinical presentation, preoperative evaluation, operative technique, and results and complications of therapy are discussed. Consideration is also given to the pathogenesis of intrathoracic extension. The transcervical approach for resection is emphasized--even goiters extending to the aortic arch were safely removed without requiring sternotomy. A multidisciplinary team approach, including the surgeon, anesthesiologist, and endocrinologist, is essential. Because of more conservative trends in the selection of patients for thyroidectomy, the incidence of mediastinal goiter may be increasing.
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PMID:Management of substernal and intrathoracic goiters. 308 54

Patients with acute suppurative thyroiditis usually have pain or tenderness in the anterior part of the neck associated with erythema and dysphagia. An elderly man with none of these symptoms presented with fever and a urinary tract infection. When his systemic infection failed to respond to antibiotics, a search for an occult abscess was undertaken. An 111Indium leukocyte scan indicated a localized abscess in the right lobe of his thyroid from which Escherichia coli and Staphylococcus aureus coagulase positive were isolated. This case demonstrates that a thyroid abscess can occur in a completely asymptomatic patient without a clinically enlarged thyroid.
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PMID:Combined Escherichia coli and Staphylococcus aureus thyroid abscess in an asymptomatic man. 327 9

Fourteen patients with large non-toxic multinodular goiters were treated with 20 to 100 mCi (740 to 3,700 MBq) of radioactive iodine (iodine-131). In seven, the goiter had recurred after a partial thyroidectomy and four of these had had two operations. Eight had symptoms of respiratory obstruction, two had dysphagia, and the others sought treatment for cosmetic reasons. After administration of iodine-131, there was a significant decrease in goiter size in 11 of the 14 patients, and all those with obstructive symptoms showed improvement. No significant local side effects occurred, but hypothyroidism and Graves' disease each occurred once during follow-up from one to 13 years. Radioactive iodine in doses of 20 to 100 mCi is an effective, safe therapeutic alternative in patients with large non-toxic multinodular goiter, particularly when there is recurrence following surgery or when there are contraindications to surgery.
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PMID:Treatment of non-toxic multinodular goiter with radioactive iodine. 333 30

Surgical treatment was applied to 18 patients for intrathoracic struma. Dyspnoea, dysphagia, recurrent palsy, and dilatated cervical veins with facial flushing were indications for surgery. Surgical access routes depended on localisation of the intrathoracic struma and its connection to the thyroid gland. Goitre located in the anterior mediastinum (substernal) can be extirpated, using the cervical approach (Kocher). Sternotomy was found to be necessary only in cases with tracheal resection. Goitres located in the posterior mediastinum were removed by means of right or left thoracotomy. Postoperative "collapse" of the posterior tracheal wall in patients with extreme dislocation of the trachea was successfully avoided by means of intratracheal intubation for 24 hours.
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PMID:[Surgical treatment of intrathoracic struma]. 363 Apr 55

The literature on substernal goiter from the seventeenth century to the present is reviewed. Substernal goiter may be defined as any thyroid enlargement that has its greater mass inferior to the thoracic inlet. Truly ectopic mediastinal goiters are rare, and most substernal goiters arise from and maintain some attachment to the cervical thyroid gland. Patients are generally in the fifth decade of life, and women predominate. Most patients experience dyspnea, stridor, or dysphagia, but 15 to 50% are asymptomatic; symptoms are often positional, and acute stridor may occur. Ten to twenty percent have no cervical mass or tracheal deviation on examination, and virtually all patients are euthyroid. Standard chest roentgenograms are often diagnostic, but computed tomographic or radioactive iodine scans may be helpful. The presence of a substernal goiter in all but the highest-risk patients is an indication for resection, usually through a cervical collar incision; an occasional patient will require sternotomy or thoracotomy. Death or major complications should be rare postoperatively. Substernal goiters are adenomatous and benign, but carcinoma occurs in 2 to 3% and may be occult. Patients should be followed closely, as these goiters may recur.
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PMID:Substernal goiter. 388 87

Eighty patients at the Massachusetts General Hospital underwent resection of substernal goiter in the years 1976 to 1982. Mean age of the 50 women and 30 men was 56 years, and 10 (19 percent) had undergone prior thyroid surgery. The most common symptoms were cervical mass (69 percent), dysphagia (33 percent), and dyspnea (28 percent); 13 percent were asymptomatic. On examination, cervical mass was present in most (90 percent) but not all patients, 51 percent were obese, and more than one third had tracheal deviation. Fifty-one of 52 patients tested were euthyroid and one was mildly hypothyroid. Chest radiographs showed tracheal deviation in 79 percent and soft tissue mass in 56 percent. Seventy-eight patients underwent resection through a cervical collar incision only; one had cervical incision plus upper partial sternotomy; and one required cervical incision plus full median sternotomy. Pathologic examination revealed multinodular goiter in 41 (51 percent), follicular adenoma in 35 (44 percent), and Hashimoto's thyroiditis in 4 (5 percent). Mean goiter weight was 104 g, and the mean greatest dimension was 9 cm. Occult papillary carcinoma was found in two patients. There were no deaths or major complications. Analysis of our data indicate the following: (1) Substernal goiter may exist in the absence of symptoms or signs. (2) Extensive radiologic evaluation and thyroid function testing are rarely required. (3) With rare exceptions, substernal goiter represents an extension of a cervical growth through the thoracic inlet and can be approached through a cervical collar incision. (4) Histologically, these are multinodular goiters or follicular adenomas, although Hashimoto's thyroiditis may occur. (5) Given the small but present risks of acute stridor or occult malignancy and the negligible surgical risk, operation should be recommended. (6) Patients should be followed since, with or without levothyroxine, goiters may recur.
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PMID:Substernal goiter. Analysis of 80 patients from Massachusetts General Hospital. 397 Mar 28

During the course of 872 thyroidectomies performed at the University of Michigan Medical Center between 1972 and 1982, 50 patients (5.7%) were found to have substernal goiters, 42 of which were benign and eight malignant (16%). Symptoms included airway compression (22 patients), dysphagia (13 patients), hoarseness (four patients), weight loss (three patients), and thyrotoxicosis (10 patients). Five patients with compression symptoms, four of whom had benign disease, had superior vena cava syndrome. Most patients were elderly (mean age 66 years), were women (3.2 women:1 man), and had long-standing goiters (mean duration 16 years). All but one operation was performed through a cervical incision. There were no intraoperative deaths. Complications were: pneumonia (one patient), wound hematoma (one patient), transient hypocalcemia (two patients), and atrial fibrillation (two patients). This series illustrates five reasons to support operative management. (1) There is no other treatment for long-standing large multinodular goiters. (2) Iodine 131, the alternative to operation for patients with large thyrotoxic goiters, can precipitate acute reactions in the elderly that can result in respiratory distress. (3) A long history of having a large multinodular goiter precluded neither malignancy, hyperfunction, nor complications such as tracheal or esophageal compression. (4) Malignancy occurs in a significant number of these lesions, which are inaccessible to needle biopsy. (5) Nearly all substernal goiters can be removed through a cervical incision. Presence of a substernal goiter is in itself an indication for operation.
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PMID:Rationale for the operative management of substernal goiters. 664 12

Thirty-one patients were operated on for benign thyromegaly extending to the thorax in an 11-year period at the University of Alabama in Birmingham. Neck mass (65%), dysphagia (36%), and dyspnea (32%) were the most common symptoms. All patients were euthyroid. Five patients had previous thyroid surgery. A thyroid scan was performed on 24-patients. Fourteen (58%) suggested a thoracic extension while ten (42%) failed to identify a thoracic extension. The indications for resection were increasing symptoms, increasing size despite the use of dessicated thyroid therapy, and to establish a diagnosis. The left thyroid lobe extended into the thorax more frequently (70%) than the right. Most patients had multinodular goiter (94%). Three patients had occult carcinoma (10%) and two patients had Hashimoto's disease. Median sternotomy combined with a collar incision to provide exposure for excision of intrathoracic thyroid extension was used in six patients. There was no operative mortality. There was no increase in operative morbidity and a slight increase in average stay from 5.3 days with a collar incision alone to 6.8 days with the combined incisions. Median sternotomy does not increase morbidity or mortality. Specific indications for more liberal use of sternotomy extension of a collar incision are proposed for the management of substernal and intrathoracic goiters.
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PMID:Substernal and intrathoracic goiter. Reconsideration of surgical approach. 688 26

Lymphoma of the thyroid gland is usually seen as a rapidly enlarging goiter in older persons, and is associated frequently with dysphagia, hoarseness, and choking. There is infrequent vocal cord paralysis. Three patients with malignant lymphoma seen in a two-year period were hoarse without vocal cord paralysis. Two of them had biopsy-proven lymphoma from within the subglottic trachea.
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PMID:Hoarseness associated with lymphoma of the thyroid gland. 714 96

Tracheal or esophageal compression was present in 91 (33 percent) of 273 consecutive patients with benign goiter during a 7 year experience. The underlying disease was nodular colloid goiter in 66 percent, adenoma in 21 percent, thyroiditis in 9 percent and Graves' disease in 4 percent. The incidence of tracheoesophageal compression was higher in patients with thyroiditis (67 percent) than in those with colloid goiter (46 percent). Thirty of 91 patients were completely asymptomatic but had marked tracheal deviation on roentgenography. Two thirds presented with significant dyspnea, or dysphagia or both. A long history of goiter preceding the onset of symptoms and progressive worsening of compression symptoms after its onset were common in the latter group. Previous radiographs demonstrating significant tracheal deviation during a previous presymptomatic period were available in 11 of 36 dyspneic patients. Sudden tracheal occlusion developed in 3 percent and required emergency treatment. Tracheal compression occurred more often and when present was a more ominous symptom. Compression manifestations were more frequent in patients with multinodular goiter, were more likely to appear when the underlying disorder was thyroiditis affected the tracheal more often than the esophagus and were generally gradually progressive with time. A clinical spectrum ranging from a presymptomatic tracheal compression stage to one wherein progressive worsening of symptoms occurs is suggested. After symptoms of tracheal compression become clinically manifest, the occurrence of complete airway occlusion may be sudden and unpredictable. Early operation whenever roentgenographic evidence of tracheal deviation becomes manifest is recommended.
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PMID:Tracheal or esophageal compression due to benign thyroid disease. 728 26


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