[Surgical treatment of acute respiratory failure caused by mediastinal goiter. Clinical experience and results].

In the regions where goitre is endemic, onset of the disease with acute respiratory insufficiency caused by thyroid compression is an uncommon situation requiring a rapid diagnosis and urgent surgical treatment. From January 1997 to December 2000 we observed 81 patients with thyroid pathologies, (69 males and 12 females; mean age 64 years). We found colloid-cystic goitre in 39 cases, adenomatous goitre in 26, carcinoma in 12, Hürthle's cell tumours in 3 and inflammatory disease in 1. All patients underwent thyroidectomy. Nine patients (11%) presented acute respiratory insufficiency caused by thyroid compression, with various associated phonesis disorders; in these cases we performed emergency surgery with postoperative maintenance of tracheal intubation or tracheotomy or the possible positioning of a self-expanding tracheal stent. In these 9 patients there were 4 deaths (44%), 3 in the immediate postoperative period and one after 10 months. We also observed one hydropneumothorax. Functional recovery was achieved in the remaining 5 patients. The treatment of this clinical picture requires urgent tracheal intubation, before the use of diagnostic tools, and it is important to maintain it after the surgical procedure for as long as is necessary for the tracheal wall to be reconstituted. In the severest cases a temporary tracheotomy is needed or the positioning of a tracheal stent, which offers a valid and effective alternative.