{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T02:52:51Z","timestamp":1790045571424,"version":"4.0.1"},"reference-count":29,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T00:00:00Z","timestamp":1741132800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Recep Tayyip Erdo\u011fan University Development Foundation","award":["02025001027261"],"award-info":[{"award-number":["02025001027261"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: This study investigates the effect of thyroid lobe size on common carotid artery hemodynamics during thyroidectomy. While prior research has reported reduced carotid blood flow during the procedure, the impact of thyroid size remains unclear. We hypothesized that larger thyroid lobes may influence carotid flow dynamics via external compression. Methods: Adult patients undergoing elective thyroidectomy were prospectively included. Doppler ultrasonography measured carotid artery diameters and flow characteristics at three time points: before anesthesia induction, after induction, and after surgical positioning. Regional cerebral oximetry was recorded. Each carotid artery was analyzed separately. Results: Data from 202 carotid arteries (132 patients) were analyzed. Baseline carotid diameters and flow velocities were similar between patients with normal and large thyroid lobes. Anesthesia induction reduced flow velocities in all patients. After surgical positioning, patients with large thyroid lobes had significantly increased peak systolic velocity, leading to an overestimation of carotid blood flow, when using formula-based calculations. Manually traced Velocity Time Integral confirmed the increase in peak systolic velocity and a shortened systolic\/diastolic ratio in these patients. Receiver operating characteristic analysis identified a thyroid lobe volume cutoff of 19.7 mL (AUC: 0.93, Sensitivity: 85%, Specificity: 98%). Regional cerebral oxygen saturation remained unchanged (p &gt; 0.05). Conclusions: Larger thyroid lobes are associated with altered carotid flow dynamics during thyroidectomy, emphasizing diastolic flow. While these findings provide insight into thyroid-related hemodynamic changes, their applicability to patients with pre-existing carotid stenosis or peripheral artery disease remains uncertain, as our study population did not include such cases.<\/jats:p>","DOI":"10.3390\/jcm14051743","type":"journal-article","created":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T03:18:22Z","timestamp":1741144702000},"page":"1743","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Effect of Thyroid Lobe Volume on the Common Carotid Artery Blood Flow in Thyroidectomy Position"],"prefix":"10.3390","volume":"14","author":[{"given":"Neslihan","family":"Hat\u0131no\u011flu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3955-8242","authenticated-orcid":false,"given":"Basar","family":"Erdivanli","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Faculty of Medicine, Recep Tayyip Erdogan University, 53100 Rize, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s12020-020-02397-z","article-title":"Thyroid function and risk of all-cause and cardiovascular mortality: A prospective population-based cohort study","volume":"71","author":"Groothof","year":"2021","journal-title":"Endocrine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1007\/s12020-022-02982-4","article-title":"Thyroid disorders and cardiovascular manifestations: An update","volume":"75","author":"Paschou","year":"2022","journal-title":"Endocrine"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Jakubiak, G.K., Pawlas, N., Morawiecka-Pietrzak, M., Zalejska-Fiolka, J., Stanek, A., and Cie\u015blar, G. (2024). Relationship of Thyroid Volume and Function with Ankle-Brachial Index, Toe-Brachial Index, and Toe Pressure in Euthyroid People Aged 18\u201365. Medicina, 60.","DOI":"10.3390\/medicina60091445"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Jakubiak, G.K., Pawlas, N., Lejawa, M., Morawiecka-Pietrzak, M., Zalejska-Fiolka, J., Stanek, A., and Cie\u015blar, G. (2025). Relationship of Thyroid Volume and Function with Carotid and Femoral Intima-Media Thickness in Euthyroid People Aged 18-65 Taking into Account the Impact of Diabetes, Hypertension, and Excess Body Mass. J. Clin. Med., 14.","DOI":"10.3390\/jcm14020604"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1097\/00003643-201206001-00086","article-title":"Head position during thyroidectomy, under general anesthesia, reduces regional cerebral oxygen saturation: 1AP8-7","volume":"29","author":"Kalogeridis","year":"2012","journal-title":"Eur. J. Anaesthesiol. EJA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"241","DOI":"10.5152\/TJAR.2016.77598","article-title":"Effects of Head Position on Cerebral Oxygenation and Blood Flow Velocity During Thyroidectomy","volume":"44","author":"Altun","year":"2016","journal-title":"Turk. J. Anaesthesiol. Reanim."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.jstrokecerebrovasdis.2009.02.007","article-title":"An Unusual Cause of Transient Neurologic Deficits: Compression of the Carotid Artery by a Thyroid Cystic Nodule","volume":"19","author":"Braakman","year":"2010","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_8","first-page":"25","article-title":"Incidental Thyroid Abnormalities on Carotid Color Doppler Ultrasound: Frequency and Clinical Significance","volume":"23","author":"Zakavi","year":"2014","journal-title":"J. Med. Ultrasound"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1053\/j.jvca.2015.07.004","article-title":"Optimal Placement of Cerebral Oximeter Monitors to Avoid the Frontal Sinus as Determined by Computed Tomography","volume":"30","author":"Gregory","year":"2016","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1038\/jcbfm.2012.93","article-title":"Effect of hypoxia and hyperoxia on cerebral blood flow, blood oxygenation, and oxidative metabolism","volume":"32","author":"Xu","year":"2012","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1148\/rg.256045013","article-title":"Sonographic examination of the carotid arteries","volume":"25","author":"Tahmasebpour","year":"2005","journal-title":"Radiographics"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s13089-017-0065-0","article-title":"Correlation of carotid blood flow and corrected carotid flow time with invasive cardiac output measurements","volume":"9","author":"Ma","year":"2017","journal-title":"Crit. Ultrasound. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1002\/acm2.13125","article-title":"Variation in thyroid volumes due to differences in the measured length or area of the cross-sectional plane: A validation study of the ellipsoid approximation method using CT images","volume":"22","author":"Fujita","year":"2021","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.diii.2013.01.023","article-title":"Elastography of the thyroid","volume":"94","author":"Monpeyssen","year":"2013","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"396","DOI":"10.2214\/AJR.14.12871","article-title":"Ultrasound elastography using carotid artery pulsation in the differential diagnosis of sonographically indeterminate thyroid nodules","volume":"204","author":"Choi","year":"2015","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E28","DOI":"10.1002\/hed.21812","article-title":"Recurrent episodes of asystole from carotid sinus hypersensitivity triggered by positioning for head and neck surgery","volume":"35","author":"Truong","year":"2013","journal-title":"Head Neck"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Lilitsis, E., Papaioannou, A., Hatzimichali, A., Spyridakis, K., Xenaki, S., Chalkiadakis, G., and Chrysos, E. (2016). A case of asystole from carotid sinus hypersensitivity during patient positioning for thyroidectomy. BMC Anesthesiol., 16.","DOI":"10.1186\/s12871-016-0255-5"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s11517-008-0359-2","article-title":"The arterial Windkessel","volume":"47","author":"Westerhof","year":"2009","journal-title":"Med. Biol. Eng. Comput."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1093\/qjmed\/95.2.107","article-title":"Pulse pressure and arterial elasticity","volume":"95","author":"Greenwald","year":"2002","journal-title":"QJM"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e232820","DOI":"10.1136\/bcr-2019-232820","article-title":"Case of vago-glossopharyngeal neuralgia secondary to metastatic oropharyngeal cancer","volume":"13","author":"Whitman","year":"2020","journal-title":"BMJ Case Rep"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e0225868","DOI":"10.1371\/journal.pone.0225868","article-title":"Influence of a neck compression collar on cerebrovascular and autonomic function in men and women","volume":"14","author":"Joshi","year":"2019","journal-title":"PLoS ONE"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"725751","DOI":"10.3389\/fnins.2021.725751","article-title":"Blood Pressure Regulation by the Carotid Sinus Nerve: Clinical Implications for Carotid Body Neuromodulation","volume":"15","author":"Conde","year":"2021","journal-title":"Front. Neurosci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"R136","DOI":"10.4244\/EIJV9SRA23","article-title":"Efficacy of baroreflex activation therapy for the treatment of resistant hypertension","volume":"9","author":"Briasoulis","year":"2013","journal-title":"EuroIntervention"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"98","DOI":"10.4274\/jcrpe.1818","article-title":"Normative Data of Thyroid Volume-Ultrasonographic Evaluation of 422 Subjects Aged 0-55 Years","volume":"7","author":"Turan","year":"2015","journal-title":"J. Clin. Res. Pediatr. Endocrinol."},{"key":"ref_25","first-page":"239","article-title":"Flow volume in the common carotid artery detected by color duplex sonography: An approach to the normal value and predictability of cerebral blood flow","volume":"18","author":"Chu","year":"2000","journal-title":"Radiat. Med."},{"key":"ref_26","first-page":"e70064","article-title":"Valsalva Maneuver Versus Carotid Sinus Massage for Supraventricular Tachycardia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"16","author":"Alfehaid","year":"2024","journal-title":"Cureus"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1093\/eurheartj\/ehx717","article-title":"Exaggerated exercise-induced sytolic blood pressure response: Arterial baroreceptor sensitivity or carotid stiffness?","volume":"39","author":"Chaitman","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"11","DOI":"10.14366\/usg.13018","article-title":"General principles of carotid Doppler ultrasonography","volume":"33","author":"Lee","year":"2014","journal-title":"Ultrasonography"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1179\/106698109790818160","article-title":"Vertebral Artery Blood flow Velocity Changes Associated with Cervical Spine rotation: A Meta-Analysis of the Evidence with implications for Professional Practice","volume":"17","author":"Mitchell","year":"2009","journal-title":"J. Man. Manip. Ther."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1743\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:47:24Z","timestamp":1760028444000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1743"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,5]]},"references-count":29,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jcm14051743"],"URL":"https:\/\/doi.org\/10.3390\/jcm14051743","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,5]]}}}