| In addition to evaluation of the nature of nodular thyroid enlargement as discussed below, management is also determined in part by the size of the thyroid lesion and in particular by the presence or absence of tracheal compression. Plain X-ray examination of the trachea may reveal deviation or compression of the airway, although comparison of the specificity and sensitivity of plain radiology with findings from CT scanning of the trachea has revealed that X-ray findings are often misleading (19). Assessment of a respiratory flow volume loop is regarded the best method for evaluation of upper airways obstruction (20) and we have recently performed a prospective study of this method for assessment of the airway. We found that inspection of flow volume loops revealed upper airways obstruction in up to one third of patients presenting with nodular thyroid disease and that symptoms such as choking or breathlessness were poor predictors of this functional upper airways obstruction (21). It is as yet unclear whether flow volume loop evidence of tracheal obstruction in the asymptomatic patient warrants surgical treatment. |
