Substernal thyroid goiters: study of patients operated in a teaching university service

• Grant number: 14/10037-1
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: August 01, 2014
• End date: July 31, 2015
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Claudio Roberto Cernea
• Grantee: Mariana Gonçalves Rodrigues
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

The substernal goiters ( SG ) , those in which there is a thyroid extension beyond the limits of the neck to the mediastinum are usually very voluminous and represent a major portion of thyroidectomies performed at the Disciplina de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo ( DCCP - HCFMUSP ).The incidence of SG is very variable in the literature, between 5 and 20 %. This difference is explained by the absence of a clear definition of SG. Rios et al found 10 different definitions of SG. It depends on the surgeon, and clinical and radiological data. For this reason it is quite difficult to compare the results of studies in this subject.In DCCP - HCFMUSP we use clinical criteria to define SG and imaging studies to determine the degree of mediastinum extension.The caudal extent of the goiter became substernally by a number of reasons. There is low resistance due to negative pressure in the chest, no anatomical barrier to the descent, swallowing impulse, gravity, and patients with a short neck and trachea, especially those with well-developed neck muscles.Treatment of SG is rather surgical.In this situation the surgery is harder and prolonged, with a higher rate of complications during and after surgery. Sometimes thoracotomy is necessary to access intrathoracic portion of the goiter.Articles in this issue generally have small sample size. This study aims to survey the series of thyroidectomies performed for the DCCP SG - HCFMUSP, a college education service , with large number of surgeries for this situation . The emphasis is on complications and the need for thoracotomy. The data will be compared to an equivalent group of thyroidectomy for the limited neck disease.Patients and methodsRetrospective survey of thyroidectomy made SG (Group 1) and an equivalent number of exclusive thyroidectomy for cervical disease (Group 2).The search will be performed in a spreadsheet with clinical and surgical data of all surgeries Sector Benign Thyroid Diseases of DCCP - HCFMUSP.The data to be studied are:1 - Patient Identification2 - Thyroid function and the presence of autoantibodies3 - Use of medications for hyper or hypothyroidism4 - Respiratory and digestive compressive symptoms preoperatively5 - Findings US and CT and / or MRI6 - Puncture biopsy7 - preoperative laryngoscopy8 - Type of surgery (partial or total thyroidectomy)9 - Surgery duration10 - Necessity and type of thoracotomy11 - Dysphonia postoperative (clinical and laryngoscopy)12 - Postoperative parathyroid function (calcium, PTH)13 - Postoperative hematoma14 - Need for tracheostomy15 - Mortality16 - Drain Debit17 - Hospital discharge day18 - Pathologic Results19 - Permanent Hypoparathyroidism20 - recurrent nerve definitive Injury In comparing the two groups for statistical analysis , we use the analysis of variance for continuous variables and Fisher exact test for nonparametric variables , and the differences were considered significant when p < 0.05 .This study is part of a research project approved by Cappesq in 2011: Study of complications of thyroidectomy in a University Service of Teaching.Relevance:This survey will have one of the largest series of SG has published in the literature and will show our experience in treating these difficult cases considered by specialists in Head and Neck Surgery. We will study if the percentage of thoracotomy and the specific complications of thyroid surgery are different from cervical disease exclusively operations.