Clinicopathological profile, airway management, and postoperative complications in huge goiters: a retrospective analysis of 33 cases

Purpose: The aim of this study was to identify the clinical and pathological features of patients with huge goiters and to investigate the relationship between tumor size, retrosternal extension, and the incidence of postoperative complications. Materials and Methods: All patients with huge goiters in the 5 years from 2018 to 2023 were reviewed in retrospect. The patients' clinicopathological and demographic details were recorded. Data from computed tomography scans were used to select the study patients. The study covered patients whose thyroid gland size was greater than 10 cm. Results: The study comprised 33 patients who met the inclusion criteria. Dyspnea was the most frequent symptom of compression (75.7%). Tracheal compression was observed in 15 cases (45.4%). Nineteen patients (57.5%) had retrosternal extension. Two patients experienced permanent recurrent laryngeal nerve paralysis postoperatively, while eleven patients exhibited transient hypocalcemia. No significant differences were found between male and female patients regarding clinicopathological characteristics and complications. Furthermore, there was no evidence indicating that retrosternal extension or increased goiter size elevated the risk of complications. Conclusion: Surgery remains the most effective way to quickly relieve compression symptoms in patients with huge goiters. Our experience indicates that thyroidectomy via a cervical incision can be safely conducted in nearly all patients with huge goiters, regardless of the presence of retrosternal extension, without elevating the risk of complications.