Chest
Clinical InvestigationsMassesOrthopnea and Tidal Expiratory Flow Limitation in Patients With Euthyroid Goiter
Section snippets
Patients
A cross-sectional study was carried out on 32 consecutive outpatients (12 male) with nontoxic goiter. The diagnosis was made at the Endocrinology Unit, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy, by ultrasonography and/or nuclear imaging of the thyroid, and by measuring thyrotropin, free tri-iodothyronin, and free thyroxin concentrations. A classification of goiter based on clinical examination has been provided by Thillu14 for the World Health Organization; for this study, only
Results
Tables 1, 2 show the anthropometric, clinical, and baseline respiratory function data for all 32 patients and three subgroups stratified according to the 3-point goiter effect on the trachea. All subgroups included a few obese patients (BMI > 30). Static lung volumes, total lung capacity (TLC), functional residual capacity (FRC), residual volume (RV), as well as FVC were, on average, lower in group C than in groups A and B, though the difference was significant only in the case of ERV between
Discussion
The main finding of the present study is that tidal FL, as reflected by the 3-point FL score, is the strongest risk factor for reported orthopnea in patients with euthyroid goiter, and that this phenomenon is enhanced by concurrent obesity. Orthopnea probably results from increased inspiratory work in supine position due to increased inspiratory resistance, elastance of respiratory system (Ers) and, more importantly, intrinsic positive end-expiratory pressure caused by dynamic hyperinflation.
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