Does a combined procedure for cardiac surgery and thyroidectomy offer acceptable outcomes?

This best evidence topic on cardiothoracic surgery was written using a structured protocol. The question addressed was: 'in an adult patient requiring cardiac surgery, can a thyroidectomy for a large retrosternal goitre be performed with good outcomes as a combined procedure?' Of 150 papers identified through the literature search, 16 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, study type, patient group studied, relevant outcomes and results were tabulated. This paper includes 3 Level 4 papers and 13 case reports. All papers reported postoperative outcomes and five papers reported intraoperative outcomes. Of a total cohort of 32 patients, 25 were euthyroid prior to combined surgery. Twenty-nine of 32 thyroid surgeries were performed immediately prior to cardiac surgery in the combined procedure sequence. Post-procedural complications including transient recurrent laryngeal palsy and tracheomalacia were reported in 8 patients. There was one intraoperative death. Where reported, all patients were euthyroid on follow-up. All identified papers reported good outcomes with combined thyroidectomy and cardiac surgery.