Diagnosis and surgical treatment of giant goiter

Objective: This study aimed to summarize the experience in diagnosis and surgical treatment for giant goiter. Methods: The clinical features of 66 patients with giant goiter were retrospectively reviewed, and the perioperative management, postoperative complications and treatments were summarized. Results: All the patients received surgical treatment: total thyroidectomy in 46 patients, bilateral subtotal thyroidectomy in 4, unilateral thyroid lobectomy in 14, and total thyroidectomy combined with cervical central lymph node dissection in 2 for thyroid cancer. Cervical incision was made in 61 patients, and surgery through cervical and thoracic incision was performed in 5. The patients were pathologically diagnosed with bilateral nodular goiter (n=50), unilateral nodular goiter (n=10), unilateral simple goiter (n=4), and thyroid papillary carcinoma (n=2). Thyroid crisis, dyspnea and other severe complications were not observed after surgery. Postoperative bleeding was found in 4 patients, hoarseness in 6 and drinking choke in 4, but all recovered within one week. Five patients developed lip numbness and limb twitching, but recovered within one month after calcium treatment. All patients were followed up for 6 months to 10 years. Patients receiving thyroidectomy were treated with oral thyroxine sodium, and recurrence was not observed. Conclusion: The preoperative diagnosis of giantgoiter is relatively easy, and ultrasound examination and computerized tomography are helpful for the definite diagnosis. The clinicians should understand the surgical indications and rational perioperative management. Total thyroidectomy or unilateral lobectomy is preferred for giantgoiter. The prevention against intraoperative injury to the blood vessel, trachea, esophagus, nerves and parathyroid is a key for successful surgery.