Surgery for fibro-adherent inflammatory thyroid disease

Publication date: March 2018

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 29, Issue 1

Author(s): David Goldenberg, Warren Swegal, Mitchell Dunklebarger, Phillip K. Pellitteri

Inflammatory thyroid diseases include those which are mediated through autoimmune disorders such as Hashimoto thyroiditis and Graves disease, as well as inflammatory goiter and subacute thyroiditis. In patients with such disorders, the thyroid gland often becomes markedly enlarged with an associated fibro-vascular connective tissue reaction involving the thyroid capsule and surrounding soft tissues. This results in dense, adherent connective tissue which may compress and obscure critical central neck compartment structures and make capsular dissection challenging. Thyroid surgery in patients with fibro-adherent inflammatory thyroid disease is technically challenging and postoperative complication rates are higher for these procedures. Due to these increased risks for complications, operative procedures in these circumstances should be designed with careful consideration of the anatomical changes associated with the underlying inflammatory pathology. Elements important to successful surgical resection include appropriate patient preparation and surgical planning, together with execution of the operative procedure with adaptation to many of the changes induced by inflammation on both the thyroid gland and the surrounding central neck structures.

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