Thyroid Compressive Symptoms: An Evaluation of Preoperative Workup and Outcomes.

OBJECTIVE: Thyroid compressive symptoms encompass a range of aerodigestive symptoms including globus sensation, dysphagia, dyspnea, and neck pressure. However, these symptoms can also be caused by other conditions. This study evaluates workup, treatment, and outcomes for patients presenting with "compressive symptoms" attributed to thyroid pathology. METHODS: Patients referred to Otolaryngology clinic at a single academic center from 2015 to 2025 for compressive symptoms attributed to thyroid nodules, goiter, or cysts were included. Demographics, symptoms, imaging findings, treatment, and pathology were correlated with symptom resolution. Wilcoxon rank-sum test was used to compare nodule size, chi-square tests of independence tested associations, and simple logistic regression assessed causation. RESULTS: Two hundred fourteen patients (87% female, average age = 50) were included. Eighty-two (38%) patients underwent thyroid surgery; 83% (n = 69) reported improvement post-operatively. Among patients not recommended for surgery (n = 110), globus sensation (n = 18) and dysphagia (n = 21) were the most common symptoms. Gastroesophageal reflux disease (GERD) (n = 39, 36%) and laryngeal muscle tension (n = 39, 23%) were the most common alternate diagnoses. Median thyroid nodule volumes were higher in patients who underwent surgery than those who did not (36.41 vs. 6.38 cm3, p < 0.05). Patients with dyspnea (n = 35, p < 0.01) and orthopnea (n = 29, p < 0.01) were more likely to be recommended for surgery. Patients with orthopnea had the highest rate of symptom resolution after surgery (91%). CONCLUSIONS: Alternative conditions, including GERD and muscle tension disorders, can cause symptoms attributed to thyroid compression. Patients selected for surgery, particularly those with larger nodules, dyspnea, and orthopnea, demonstrate high rates of symptom improvement after surgery.