ORIGINAL ARTICLE Impact of thyroidectomy on the control of obstructive sleep apnea syndrome in patients with large goiters Leonardo Haddad & Fernanda L. Martinho Haddad & Lia Bittencourt & Luis Carlos Gregório & Sergio Tufik & Marcio Abrahão Received: 22 October 2013 /Revised: 29 January 2014 /Accepted: 30 January 2014 # Springer-Verlag Berlin Heidelberg 2014 Abstract Purpose A large goiter can cause a series of compressive symptoms such as dyspnea and dysphagia, and previous case reports have indicated the coexistence of obstructive sleep apnea syndrome (OSAS) in these patients. The aim of this study was to evaluate the impact of thyroidectomy on the control of OSAS in patients with large goiters. Methods Twenty-four patients with euthyroid goiters larger than 100 ml were consecutively selected. Of these, 17 (70.8 %) presented OSAS and formed the research group. The protocol consisted of sleep questionnaires, physical ex- amination, and polysomnography in baseline and after 3 months of surgery. Results The average age of the patients was 58.3±9.9 years, and there were 5 (29.4 %) males and 12 (70.6 %) females. The significant findings in the postoperative period included a reduced neck circumference (p =0.041), reduced Epworth sleepiness score (p =0.025), decreased percentage of high-risk OSAS cases according to the Berlin question- naire (p <0.001), and a tendency for a significant reduc- tion in snoring (p =0.052). However, polysomnographic respiratory parameters showed no significant improve- ment after surgery. Conclusion Despite the high prevalence of OSAS in patients with large goiters and the improvement of OSAS symptoms, thyroidectomy showed no significant impact on the polysom- nographic parameters. Keywords Sleep apnea . Thyroid . Goiter . Polysomnography . Physical examination Introduction Euthyroid goiters are generally asymptomatic, but as they grow, they can begin to cause symptoms due to the compres- sion of local structures. In such cases, these are referred to as large goiters, and the main reported symptoms include foreign body sensations in the oropharynx, dysphagia, dyspnea, and orthopnea [1]. Case studies [2–4] have also demonstrated the coexistence of large goiters and obstructive sleep apnea syndrome (OSAS). Large goi- ters may make the upper airway (UA) more susceptible to collapse due to extrinsic compression and for undermining the caudal traction at the end of expiration [5]. Although most studies have not made an objective assessment of sleep using polysomnography, some re- sults have shown improved breathing symptoms during sleep after thyroidectomy [2–4]. One previous study conducted a standard evaluation using polysomnography and clinical criteria for the diagnosis of OSAS in a group of patients with large goiters and found a prevalence of OSAS of 70.8 %, which was significantly higher than that reported for the same age group in other population studies [6]. In a case series study, Agrama et al. demonstrated improvement in respiratory polysomnographic parameters with a reduction in the apnea–hypopnea in- dex (AHI) after completion of thyroidectomy in patients with large goiters [7]. This study was performed at the Universidade Federal de São Paulo – UNIFESP – Brazil. L. Haddad : F. L. Martinho Haddad : L. C. Gregório : M. Abrahão Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço da Universidade Federal de São Paulo/UNIFESP, São Paulo, Brazil F. L. Martinho Haddad (*) : L. Bittencourt : S. Tufik Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo/UNIFESP, Rua Napoleao de Barros, 925, Vila Clementino, São Paulo, SP, Brazil 04024-002 e-mail: femartinho@uol.com.br Sleep Breath DOI 10.1007/s11325-014-0950-8