Surgical Outcome of Giant Goiters: A Retrospective Observational Study.

INTRODUCTION

Surgical management of giant goiters is often challenging due to distorted anatomy and proximity to vital structures in the neck.

OBJECTIVE

We aimed to evaluate the outcomes of patients operated on for giant goiters (size >10 cm) compared to non-giant ones (size ≤10 cm).

METHODS

This retrospective study included 132 patients undergoing total thyroidectomy for various etiologies over 36 months (January 2022 to December 2024) in a single surgical unit of a tertiary care hospital. Clinical and surgical management details were noted from the electronic database and medical records. Data were analyzed by IBM SPSS Statistics for Windows, version 27 (IBM Corp., Armonk, NY, USA).

RESULTS

Outcomes of 36 (27.2%) patients operated on for giant goiters were compared with 96 (72.8%) cases of non-giant goiters. Though the median duration of symptoms was significantly longer in patients with giant goiters than in those with non-giant goiters (66.0 (24.0-172.0) vs. 24.0 (8.0-69.0) months; p=0.005), the frequency of compressive symptoms was comparable between the two groups. Mean±SD size (cm) of giant goiters was 13.8±3.6, significantly higher than the size of non-giant goiters (7.2±1.6). Malignant pathology was significantly less frequent in patients with giant goiters than in those with non-giant goiters (44.4% vs. 67.8%; p = 0.039). Median duration of surgery, intraoperative blood loss, and duration of hospital stay were significantly higher for patients with giant disease. Although mean postoperative day-1 serum calcium levels were comparable between groups, the need for postoperative mechanical ventilation (16.7% vs. 1.0%; p = 0.002), tracheostomy (13.9% vs. 1.0%; p= 0.006), and postoperative recurrent laryngeal nerve palsy (13.9% vs. 4.2%; p = 0.048) was significantly higher in patients with giant disease. Other postoperative complications, including hypocalcemia rates, were similar.

CONCLUSION

Giant goiters were associated with greater intraoperative blood loss and higher frequencies of postoperative mechanical ventilation, tracheostomy, and recurrent laryngeal nerve palsy, while the incidence of hypocalcemia was comparable between the groups.