Substernal goiter and laryngopharyngeal reflux

ABSTRACT Objective This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal goiters and voluminous cervical goiter without thoracic extension. Subjects and methods A retrospective case-control study was performed with data retrieved of the charts of the patients submitted to thyroidectomies occurred at a tertiary care center (Head and Neck Surgery Department, University of São Paulo Medical School) between 2010 and 2014. The selected thyroidectomies were allocated in two groups for study: patients with substernal goiters and patients with voluminous cervical goiter without thoracic extension. Cervical goiters were selected by ultrasonography mensuration. Clinical criterion was used to define substernal goiter. Results The average thyroid volume in patients with substernal goiter was significantly greater than the average volume in patients with only cervical goiter (p < 0.001). The prevalence of signs of reflux laryngitis at laryngoscopy was significantly greater in substernal goiter patients (p = 0.036). Moreover, substernal goiter was considered as the unique independent variable for high reflux laryngitis signs at laryngoscopy (OR = 2.75; CI95%: 1.05-7.20; p = 0.039) when compared to only cervical goiter patients. Conclusion This study shows a significant association between substernal goiters and signs of laryngopharyngeal reflux at preoperative laryngoscopy. Therefore, when compared with voluminous cervical goiters, the substernal goiters increase the chance of reflux laryngitis signs in patients.

摘要
目的：本研究旨在对比两组因巨大甲状腺肿行甲状腺切除术（thyroidectomy）的患者的喉咽反流（laryngopharyngeal reflux）体征患病率：胸骨后甲状腺肿（substernal goiters）组与无胸内延伸的巨大颈甲状腺肿（voluminous cervical goiter without thoracic extension）组。
对象与方法：本研究为回顾性病例对照研究，数据提取自2010年至2014年间，于某三级医疗中心（圣保罗大学医学院头颈外科）实施甲状腺切除术的患者病历。所选甲状腺切除术病例被分为两组开展研究：胸骨后甲状腺肿患者组，以及无胸内延伸的巨大颈甲状腺肿患者组。颈甲状腺肿通过超声测量进行筛选，采用临床诊断标准界定胸骨后甲状腺肿。
结果：胸骨后甲状腺肿患者的平均甲状腺体积显著高于仅伴颈甲状腺肿的患者（p < 0.001）。喉镜检查（laryngoscopy）下反流性喉炎（reflux laryngitis）体征的患病率在胸骨后甲状腺肿患者中显著更高（p = 0.036）。此外，与仅伴颈甲状腺肿的患者相比，胸骨后甲状腺肿是喉镜检查显示高反流性喉炎体征的唯一独立变量（比值比OR=2.75；95%置信区间CI95%：1.05~7.20；p=0.039）。
结论：本研究表明，术前喉镜检查下，胸骨后甲状腺肿与喉咽反流体征存在显著关联。因此，与巨大颈甲状腺肿患者相比，胸骨后甲状腺肿患者出现反流性喉炎体征的风险更高。