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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eleven malignant thyroid tumors were found in 100 consecutive patients more than sixty years old having thyroid operations. Based on preoperative findings, these 100 patients could be separated into two groups according to high and low risk for malignancy. Clinical manifestations in the high risk group were presence of a discrete cold thyroid nodule, hoarseness, dysphagia, an enlarging mass, or palpable ipsilateral cervical adenopathy; and in the low risk group, asymptomatic multinodular goiter, diffusely enlarged glands with elevated antithyroid antibody titers, and a family history of goiter. All eleven patients with malignant thyroid tumors were found in the sixty-six patients considered at high risk, whereas no malignant lesions were found in the low risk patients. Six of the malignant thyroid tumors were undifferentiated and in three of these a thyroid nodule had been present for more than fifteen years. There were no operative deaths and only one significant complication, a recurrent laryngeal nerve injury. Thyroidectomy is indicated for elderly patients with thyroid nudules who have features of the high risk group, whereas patients in the low risk group can be safely followed.
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PMID:Management of thyroid nodules in the elderly. 98 6

Even though the incidence of multinodular goiter is decreasing in the United States, still we see a large number of neglected goiters causing pressure effects on the surrounding structures. Both tracheal and esophageal displacement cause compression symptoms. However, tracheal compression may lead to acute airway distress. Eighteen per cent of our patients presented with acute airway problems, requiring emergency admission or intubation. Surgical intervention has been our preferred approach whenever there are signs or symptoms of tracheoesophageal compression. Fifty-five per cent of patients had only tracheal compression, while 18 per cent had only esophageal compression. Twenty-seven per cent had compression of both trachea and esophagus. Eighty-five per cent of patients had some symptoms of compression, while only 15% were asymptomatic despite large goiters. Compression symptoms and acute problems were noticed more frequently in patients with substernal goiters. Our preoperative work-up regularly included complete history, physical examination, indirect laryngoscopy, and airway radiography. Barium studies were performed if patients had dysphagia. Computed tomography scans were utilized if there was mediastinal extension. Pulmonary flow volume studies were used to locate the site of compression. However, decisions relative to surgical intervention were based primarily on clinical judgment. Since the postoperative morbidity is minimal in surgery for thyroid abnormalities, we strongly recommend early surgical intervention in patients with tracheoesophageal compression caused by enlarged thyroids.
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PMID:Surgery for benign thyroid disease causing tracheoesophageal compression. 211 3

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

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

Management of thyroid tumor can be problematic in developing countries due to poor diagnostic and therapeutic facilities. This is true in Burkina Faso where there are no facilities for radioisotope scans and intraoperative biopsy is usually unfeasible due to a shortage of histologists. The purpose of this retrospective analysis of the files of 83 patients who underwent surgery of the thyroid between January 1988 and December 1993 at the National Hospital Center of Ouagadougou was to obtain information necessary to define suitable pre-, per-, and post-operative strategies for these conditions. The mean delay to consultation for the 83 patients studied was 8 years. The fact that dysphonia and/or dysphagia was present at the first examination in 68 cases and that paralysis of the recurrent laryngeal nerve was observed in 17 cases testifies to the advanced stage at which patients were seen. Cancer was confirmed in only 3 of the 41 surgical specimens that were examined (7.3%). In cases involving only one nodule with no signs of malignancy, resection of the nodule is justifiable (18.1% of cases). In other cases radical resection is indicated either by lobo-isthmectomy or subtotal thyroidectomy for diffuse or multinodular goiter (74.7% of cases) or by total thyroidectomy (7.2% of cases). The immediate postoperative period was marked by the occurrence of hemorrhage (n = 7), transient paralysis of the recurrent laryngeal nerve (n = 4), and infection of the surgical wound (n = 5). There were 2 deaths.
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PMID:[Problems after thyroid gland surgery in Burkina Faso, 83 cases]. 763 10

Intermittent throat tightness with dysphagia can be a complaint with numerous potential underlying causes. It was useful to think of this patient's complaints as secondary to an allergic, neuromuscular, or mechanical/structural disorder. Dysphagia can usually be separated into two broad categories according to location: oropharyngeal or esophageal. The patient typically can help one localize the area of involvement by pointing to the area where the difficulty in swallowing is felt to be present. This patient pointed to the throat area. Helpful diagnostic studies in the evaluation of oropharyngeal dysphagia include barium swallow with cine-esophagogram, rhinopharyngoscopy, or upper gastrointestinal endoscopy. It was interesting that this patient was referred to the Allergy Service because a physician felt that intermittent laryngeal angioedema was also a possible consideration. It is known that dysphagia, hoarseness, and sensations of throat tightness or closing frequently accompany this entity. The finding of a palpable thyroid was the clue that further evaluation of this organ was also indicated. Alfonso et al have reported on tracheal or esophageal compression secondary to benign thyroid disease. In their series, goiter, though previously felt to be associated with a low incidence, was reported to have an overall high incidence. Of the several types of thyroid disease encountered, they noted thyroiditis was associated with the highest likelihood of compression and a 67% frequency of associated obstruction. Our patient's scan and uptake findings are consistent with thyroiditis although multinodular goiter may occasionally show similar results. This case reminds us that in the differential of laryngeal angioedema and complaints associated with the throat or referred in the throat area, local extrinsic compression secondary to masses should be included. In this patient, a goiter, of which the extent of gland enlargement may not be fully appreciable on physical examination, was determined to be the etiology of her complaints. She was placed on a thyroid hormone suppression treatment regimen. At a followup visit several months later, she noted marked improvement of her symptoms with resolution of her dysphagia and episodes of throat tightness.
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PMID:Intermittent throat tightness in a 37-year-old woman. 834 59

The authors report an observation of a non-Hodgkinien primitive lymphoma of the thyroid, developed on Hashimoto's thyroiditis. The 61 years old woman was operated on a total thyroidectomy for a multinodular goiter with dysphagia. The non-Hodgkinien high-grade lymphoma infiltrated the perithyroidal tissues. The extension' assessment was negative and the lymphoma was classified stage IE. The treatment was supplemented by 6 cures of standard chemotherapy CEOP. Based on this observation and on a literature' review, we will discuss the clinical and therapeutic characteristics of this thyroid cancer.
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PMID:[Primary non-Hodgkin's lymphoma of the thyroid. A case report and review of the literature]. 1270 80

We describe the case of a 44-yr-old woman, who 2 yr after thyroidectomy for a multinodular goiter with a follicular adenoma showed a rapidly growing mass of the neck causing dysphagia and moderate pain. Fine needle aspiration biopsy revealed the presence of fibroblast-like cells, partially with atypical features and no colloid: the cytological diagnosis was suspicious for an indeterminate (mesenchymal) neoplasm. Histological diagnosis, after extensive surgery, indicated aggressive fibromatosis. Immunohistochemistry was positive for vimentin and negative for thyroglobulin. After surgery, nuclear magnetic resonance showed a persistent mass of approximately 2 cm; dysphagia and pain persisted. Therefore, the patient received external radiation therapy (total dose 60 Gy) with clinical benefit. The patient is without symptoms 1 yr after surgery.
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PMID:Aggressive fibromatosis of the neck initiated after thyroidectomy. 1655 38


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