Surgeon-performed ultrasound alters pre-operative planning in patients with endemic goiter
Peter J Mazzaglia3, *Sravanthi Puranam1, *Zhou Joy1, *Fletcher Starnes2
1Warren Alpert School of Medicine at Brown University, Providence, RI;2Albany Medical Center, Albany, NY;3Rhode Island Hospital, Providence, RI
Objective: Compare accuracy of physical exam to surgeon-performed ultrasound (SPUS) for assessment of endemic goiter
Design: Criterion standard comparison
Setting: Surgical mission trips to sub-Saharan African countries with high goiter prevalence. Operations were performed at a clinic in Migori, Kenya, and the Military Hospital in Kigali, Rwanda
Patients: 33 sequential patients from areas of endemic goiter who presented for thyroidectomy performed by an endocrine surgeon
Interventions: Surgeon-performed ultrasound using a Phillips LumifyŠ hand held probe for smart phone
Main outcome measures: nodule laterality and tracheal deviation
Results: There were 32 were females and 1 male. Median age was 50 (range 27--67) years old. Median duration of goiter was 7.5 years (range 0.6--30 years). Average goiter volume was 155.6 cc (range 31--688 cc, SD 137.3 cc). 76% of patients were symptomatic: 45% with shortness of breath, 45% with dysphagia, and 30% with voice change. Average TSH was 1.45 (SD 1.29). On physical exam, unilateral goiter was diagnosed in 66%, bilateral disease in 34%, and tracheal deviation in 47%.
SPUS differed significantly from physical exam in 42% of patients. 34% demonstrated unilateral or bilateral disease, which contradicted the physical exam findings. Discrepancies in the presence of tracheal deviation were also found in 33%. Lobectomy was performed in 66%, sub-total thyroidectomy in 25%, and total or near-total thyroidectomy in 9%. Drains were placed in 64%. Average blood loss was 48 cc (SD 69.8 cc). Complications included one hemorrhage requiring hematoma evacuation. There were no recurrent laryngeal nerve injuries and no mortality.
Conclusions: SPUS proved to be a highly valuable tool in the pre-operative evaluation of patients with endemic goiter, with implications for changing surgical planning and management.
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