Immediate effects of thyroid surgery on pulmonary dynamics of upper airway: A preoperative and postoperative comparison using flow volume loop and spirometry

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This study aims to quantify the immediate effects of thyroid surgery on the upper airway by comparing preoperative spirometry and flow-volume loop (FVL) metrics with postoperative measurements. Methods A cohort of forty adult patients who underwent thyroid surgery at the Department of Otolaryngology, Khyber Teaching Hospital, Peshawar, Pakistan from April 2023 to April 2024, was included in this study. Pulmonary function tests, including Flow volume loop (FVL) and spirometry, were performed preoperatively and after 24 hours postoperatively. The key parameters measured included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), the FEV1/FVC ratio, and the peak expiratory flow (PEF), along with the FVL curve. Results Preoperative FVC and FEV1 decreased in the immediate post-operative period (2.98 ± 0.75 vs 2.54 ± 0.74, p=0.001; 2.36 ± 0.63 vs 2.01 ± 0.63, p=0.003), but their ratio FEV1/FVC, showed no significant change (p= 0.089). Preoperative PEF reduced, in a similar way, post-operatively (5.14 ± 1.44 vs 3.23 ± 1.27, p=<0.01). While, Empey’s and Expiratory Disproportionate Indices (EDI) increased significantly (7.65 ± 2.16 vs 10.58 ± 2.45, p=<0.01; 49.08 ± 13.23 vs 60.93 ± 16.46, p=0.001). Regarding the FVL, a significantly higher number of patients exhibited fixed upper airway obstruction patterns in the postoperative period (19 vs 26, p=<0.01). Conclusion Thyroid surgery significantly affects pulmonary dynamics of the upper airway causing obstruction in the immediate postoperative period. Thus, postoperatively, careful respiratory monitoring is needed. Further research is required to determine the role of rehabilitative measures in mitigating these effects in post-thyroidectomy patients. 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F1000Research 2025, 14 :323 ( https://doi.org/10.12688/f1000research.162645.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Immediate effects of thyroid surgery on pulmonary dynamics of upper airway: A preoperative and postoperative comparison using flow volume loop and spirometry [version 1; peer review: 1 approved with reservations] Nazneen Liaqat https://orcid.org/0009-0006-0472-2088 1 , Izhar Ahmad 1 , Zeeshan Ali https://orcid.org/0009-0007-3028-4947 2 , Israr Ud Din 1 , Junaid Aziz Qadri 1 , Marwa Ibrahim Widatalla Abdalla https://orcid.org/0009-0005-2994-3859 3 Nazneen Liaqat https://orcid.org/0009-0006-0472-2088 1 , Izhar Ahmad 1 , [...] Zeeshan Ali https://orcid.org/0009-0007-3028-4947 2 , Israr Ud Din 1 , Junaid Aziz Qadri 1 , Marwa Ibrahim Widatalla Abdalla https://orcid.org/0009-0005-2994-3859 3 PUBLISHED 25 Mar 2025 Author details Author details 1 Otorhinolaryngology, Head & Neck Surgery, Khyber Teaching Hospital, MTI, Peshawar, Khyber Pakhtunkhwa, Pakistan 2 Hayatabad Medical Complex, MTI, Peshawar, Khyber Pakhtunkhwa, Pakistan 3 Otorhinolaryngology, Head & Neck Surgery, Omdurman Military Hospital, Khartoum, Sudan Nazneen Liaqat Roles: Conceptualization, Formal Analysis, Project Administration, Software, Writing – Original Draft Preparation Izhar Ahmad Roles: Data Curation, Investigation, Methodology Zeeshan Ali Roles: Formal Analysis, Software, Writing – Original Draft Preparation, Writing – Review & Editing Israr Ud Din Roles: Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing Junaid Aziz Qadri Roles: Conceptualization, Data Curation, Resources, Writing – Original Draft Preparation Marwa Ibrahim Widatalla Abdalla Roles: Formal Analysis, Software, Writing – Original Draft Preparation OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background The upper airways are at potential risk for injury during thyroid surgery because of close abutment with the gland. This study aims to quantify the immediate effects of thyroid surgery on the upper airway by comparing preoperative spirometry and flow-volume loop (FVL) metrics with postoperative measurements. Methods A cohort of forty adult patients who underwent thyroid surgery at the Department of Otolaryngology, Khyber Teaching Hospital, Peshawar, Pakistan from April 2023 to April 2024, was included in this study. Pulmonary function tests, including Flow volume loop (FVL) and spirometry, were performed preoperatively and after 24 hours postoperatively. The key parameters measured included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), the FEV1/FVC ratio, and the peak expiratory flow (PEF), along with the FVL curve. Results Preoperative FVC and FEV1 decreased in the immediate post-operative period (2.98 ± 0.75 vs 2.54 ± 0.74, p=0.001; 2.36 ± 0.63 vs 2.01 ± 0.63, p=0.003), but their ratio FEV1/FVC, showed no significant change (p= 0.089). Preoperative PEF reduced, in a similar way, post-operatively (5.14 ± 1.44 vs 3.23 ± 1.27, p=<0.01). While, Empey’s and Expiratory Disproportionate Indices (EDI) increased significantly (7.65 ± 2.16 vs 10.58 ± 2.45, p=<0.01; 49.08 ± 13.23 vs 60.93 ± 16.46, p=0.001). Regarding the FVL, a significantly higher number of patients exhibited fixed upper airway obstruction patterns in the postoperative period (19 vs 26, p=<0.01). Conclusion Thyroid surgery significantly affects pulmonary dynamics of the upper airway causing obstruction in the immediate postoperative period. Thus, postoperatively, careful respiratory monitoring is needed. Further research is required to determine the role of rehabilitative measures in mitigating these effects in post-thyroidectomy patients. READ ALL READ LESS Keywords Thyroid surgery, Spirometry, Flow-volume loop, pulmonary dynamics, Thyroidectomy, upper airway. Corresponding Author(s) Israr Ud Din ( [email protected] ) Close Corresponding author: Israr Ud Din Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Liaqat N et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Liaqat N, Ahmad I, Ali Z et al. Immediate effects of thyroid surgery on pulmonary dynamics of upper airway: A preoperative and postoperative comparison using flow volume loop and spirometry [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :323 ( https://doi.org/10.12688/f1000research.162645.1 ) First published: 25 Mar 2025, 14 :323 ( https://doi.org/10.12688/f1000research.162645.1 ) Latest published: 25 Mar 2025, 14 :323 ( https://doi.org/10.12688/f1000research.162645.1 ) Introduction The thyroid, an endocrine gland is anatomically located in the neck. There are various indications of thyroid surgery, including but not limited to the diagnosis of thyroid nodules, relief of compressive symptoms caused by an enlarged thyroid, treatment of thyroid cancers, their recurrence, and prophylactic removal in case of genetic mutations predisposing to thyroid cancer. 1 , 2 Over the past century, thyroid surgeries have developed significantly to be rendered safe due to improved anesthesia, infection prophylaxis, modern hemostatic methods, and technological improvements. 1 The most common complication after thyroid surgery is hypocalcemia, followed by seroma and recurrent laryngeal nerve palsy. 3 The thyroid gland lies close to the cricoid cartilage and tracheal rings, wrapping around these and being attached to the trachea via lateral suspensory ligament. These upper airways and the nerves supplying them (i-e, recurrent laryngeal, and superior laryngeal nerves) are at potential risk for injury during thyroid surgery due to close abutment with the gland. 2 It has been reported that thyroid surgery leads to a slight improvement of pulmonary airflow on the 10 th postoperative day followed by a significant improvement by six to twelve weeks after surgery. 4 – 6 However, the literature still lacks information regarding the impact of such surgeries on the upper airways in the immediate postoperative period. Preoperatively, only 61% of patients are informed regarding the risk of post-surgery dyspnea by their surgeons. 7 Furthermore, the Goiter Symptoms (e.g., sensation of fullness in the neck, visible swelling in the front of the neck, sensation of a lump in the throat, etc.) persist for a week after the surgery before showing any significant improvement. 8 The current study assesses the immediate effect of thyroid surgery on the airways by comparing pre-operative pulmonary dynamics with those on postoperative day 1. Methods This study was conducted prospectively at the ENT Department of Khyber Teaching Hospital, Peshawar, Pakistan from January 2023 to December 2023. It was conducted in accordance with ethical standards of institutional review board of Khyber Teaching Hospital, Peshawar, Pakistan (approval number 850/DME/KMC issued on 24/11/2022). Using non-probability convenience sampling, 40 adult patients undergoing thyroid surgery for benign euthyroid goiter were included in the study. All those patients who had any chronic respiratory disease or neck surgery in the past were excluded. Moreover, those patients who refused to participate, were not able to perform acceptable trials in spirometry, or had postoperative tracheomalacia were also dropped off. Biodata and history of the patients including name, gender, age, and history of respiratory diseases were obtained through a questionnaire. The patient’s BMI was calculated. Preoperatively, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), the FEV1/FVC ratio, and the peak expiratory flow (PEF), were measured along with a flow-volume loop (FVL) 24 hours before the surgery. MIR Spirolab spirometer with flowmeter was used, calibrated as directed by the manufacturer. All the surgical procedures were performed under general anesthesia followed by adequate postoperative analgesia. 24 hours after the surgery, the patients were assessed for pain using a visual analogue scale. At a score <3, postoperative day 1 spirometry with a flow-volume loop was done. A spirometry was considered valid if it had at least 3 acceptable trials and both the FVC and FEV1 were repeatable [i.e., the two highest values from acceptable maneuvers are within 0.15 L (150 ml)]. 9 The mean of acceptable trials was calculated. FVLs were visually interpreted by a pulmonologist as depicting upper airway obstruction (UAO) pattern or any other pattern. Empey’s and expiratory disproportionate indexes (EDI) were calculated through respective formulae. The size of the gland removed were obtained through the histopathological report. SPSS v23.0 was used for analysis. Quantitative and qualitative variables were expressed as mean ± standard deviation and percentages, respectively. Paired sample t-test was applied to measure statistical significance between means of pre-operative and post-operative measurements. Chi-square test was used to compare categorical variables. A p-value of less than 0.05 was considered as statistically significant. Results A cohort of forty adult patients undergoing thyroid surgery was included in the study. The descriptive details of the sample population are given in table 1 . Table 1. Descriptive details of the sample. No. of Patients (n) 40 Gender (Male:Female) 8:32 Age in years (Mean ± SD) 37.88 ± 8.68 BMI n(%) 30 6 (15%) Surgery n(%) Hemithyroidectomy 18 (45%) Total Thyroidectomy 22 (55%) Weight of gland removed in grams (Mean ± SD) 312.97 ± 135.27 Minimum 10 Maximum 618 Pulmonary symptoms n/N(%) Preoperative 2/40 (5%) Postoperative 22/40 (55%) Preoperative FVC, FEV1, and PEF were reduced in the immediate postoperative period and the alterations were statistically significant ( Table 2 , Figure 1 ). Conversely, Empey’s index and EDI increased, depicting obstructive effects of thyroid surgery on the upper airway. ( Table 2 , Figure 2 ). Moreover, no significant association was found between postoperative Empey’s Index and gender, BMI, extent of surgery, or size of the gland removed. Table 2. Comparison of preoperative and postoperative parameters of spirometry. Variable Preoperative Postoperative P value a FVC (L) 2.98 ± 0.75 2.54 ± 0.74 0.001 FEV1 (L) 2.36 ± 0.63 2.01 ± 0.63 0.003 FEV1/FVC (%) 82.76 ± 12.67 77.47 ± 16.36 0.089 PEF (L/s) 5.14 ± 1.44 3.23 ± 1.27 <0.01 Empey’s Index 7.65 ± 2.16 10.58 ± 2.45 <0.01 EDI (%) 49.08 ± 13.23 60.93 ± 16.46 0.001 a Paired sample t-test Figure 1. Box plot showing the distribution of preoperative and postoperative parameters of spirometry. Figure 2. Box plot showing the distribution of preoperative and postoperative Empey's Index. Regarding the FVL, a significantly higher number of patients exhibited fixed upper airway obstruction patterns in the postoperative period ( Table 3 ). Table 3. Comparison of preoperative and postoperative flow-volume loop. Variable Postoperative UAO Pattern Postoperative All other Patterns Total p value a Preoperative UAO Pattern 18 1 19 <0.01 Preoperative All other Patterns 8 13 21 Total 26 14 40 a Chi-square test, UAO-Upper Airway Obstruction Discussion Modern thyroid surgery has been refined enough, rendering it a safe and reliable surgical procedure with relief of symptoms, lower rates of complications, good cosmetic, and excellent surgical outcomes. 2 , 10 However, it is noteworthy that the health-related quality of life (HRQoL) of the patients six months after thyroid surgery remains lower than the general population. 11 This lingering impact necessitates thorough postoperative care and the need to identify the risk factors causing HRQoL deficits. It has been well reported in the literature that the UAO is quite prevalent among patients with goiter, often in the absence of any subjective respiratory symptom. 12 , 13 As per Poisseulle’s law (flow proportional to radius 4 ), minor compression of the trachea due to goiter can cause a significant reduction in airflow. This overlooked UAO may lead to acute respiratory insufficiency after thyroidectomy. 14 Six months after the surgery, substantial improvement in airflow is observed, resulting in gains in HRQoL. 6 However, this surgical intervention can paradoxically lead to worsening of the airflow in the immediate postoperative period, which can be attributed to anesthesia, manipulation of airways and nerves, post-surgery inflammation, pain, and restricted neck movements. In this study, none of the patients had any gross tracheal deviation. Regarding subjective pulmonary symptoms (dyspnea, choking, a feeling of fullness in the neck, a sensation of a lump in the throat, orthopnea, etc.), only two out of forty patients reported such symptoms preoperatively. However, 24 hours postoperatively, twenty-two subjects reported these complaints. Empey’s Index, calculated as the ratio between FEV1 (ml) and PEFR (L/min), has a high sensitivity and specificity for the detection of UAO. 5 Preoperatively, 15 patients had Empey’s Index >8, while postoperatively, this number increased to 31. Immediate postoperative derangements in pulmonary function tests after cardiac, thoracic, and abdominal surgeries have been studied extensively. 15 , 16 , 17 , 18 Interestingly, this area has not been explored in neck surgeries including thyroidectomy. Furthermore, various rehabilitation strategies, such as incentive spirometry, positive-pressure breathing techniques (i.e., bi-level positive airway pressure, continuous positive airway pressure, and intermittent positive pressure breathing), early mobilization, deep breathing exercises, and chest physiotherapies have been practiced after cardiac, thoracic and abdominal surgeries to mitigate these postoperative derangements in pulmonary dynamics. 19 , 20 Given the potential of overlooked preoperative UAO in goiter followed by alterations in pulmonary functions post-thyroidectomy, investigating rehabilitative measures in this context is a promising area for future research. Conclusion Thyroid surgery significantly affects pulmonary dynamics of the upper airway, leading to obstruction in the immediate postoperative period. This study highlights the importance of careful respiratory monitoring of patients undergoing thyroid surgery in the postoperative phase and its due management. Further research is required to explore the role of rehabilitative measures in mitigating these effects in post-thyroidectomy patients, thereby improving postoperative care and overall patient outcomes. Preregistered data analysis This research was not preregistered. Reporting guidelines STROBE checklist for ‘Immediate Effects of Thyroid Surgery on Pulmonary Dynamics of Upper Airway: A Preoperative and Postoperative Comparison Using Flow Volume Loop and Spirometry.’ https://doi.org/10.17605/OSF.IO/HS94A Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication). Declarations Ethical approval and informed consent statement The study was conducted in accordance with ethical standards of institutional review board of Khyber Teaching Hospital, Peshawar, Pakistan (approval no. 850/DME/KMC issued on 24/11/2022). All the participants were provided with information about the research, followed by a voluntary participation. This study complied with the ethical principles of the Declaration of Helsinki. Ethical considerations, including obtaining well-informed verbal consent, were addressed during the data collection process. The verbal consent was approved by the ethical board keeping in view the regional language barriers, longitudinal data collection process, convenient participation, and the right to drop out of the study at any time during the data collection process. Limitations of study This study is limited in its scope by its small sample. Data availability OSF: ‘Immediate Effects of Thyroid Surgery on Pulmonary Dynamics of Upper Airway: A Preoperative and Postoperative Comparison Using Flow Volume Loop and Spirometry.’ https://doi.org/10.17605/OSF.IO/HS94A 21 This project contains the following underlying data: Data file. Untitled2.sav Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication). References 1. Lukinović J, Bilić M: Overview of Thyroid Surgery Complications. Acta Clin. Croat. 2020; 59 (Suppl 1): 81–6. Epub 2021/07/06. PubMed Abstract | Publisher Full Text | Free Full Text 2. Roman BR, Randolph GW, Kamani D: Conventional Thyroidectomy in the Treatment of Primary Thyroid Cancer. Endocrinol. Metab. Clin. N. Am. 2019; 48 (1): 125–141. Epub 2019/02/06. PubMed Abstract | Publisher Full Text 3. Latif S, Altaf H, Waseem S, et al. : A retrospective study of complications of total thyroidectomy; is it a safe approach for benign thyroid conditions. JPMA The Journal of the Pakistan Medical Association. 2019; 69 (10): 1470–3. Epub 2019/10/18. PubMed Abstract 4. Pradeep PV, Tiwari P, Mishra A, et al. : Pulmonary function profile in patients with benign goiters without symptoms of respiratory compromise and the early effect of thyroidectomy. J. Postgrad. Med. 2008; 54 (2): 98–101. Epub 2008/05/16. PubMed Abstract | Publisher Full Text 5. Sørensen JR, Hegedüs L, Kruse-Andersen S, et al. : The impact of goitre and its treatment on the trachea, airflow, oesophagus and swallowing function. A systematic review. Best Pract. Res. Clin. Endocrinol. Metab. 2014; 28 (4): 481–494. Epub 2014/07/23. PubMed Abstract | Publisher Full Text 6. Enny L, Garg S, Mouli S, et al. : Effect of Thyroidectomy on Tracheal Remodeling and Airway Physiology in Apparently Asymptomatic Patients with Goiter: A Prospective Study. World J. Surg. 2023; 47 (12): 3222–3228. Epub 2023/10/03. PubMed Abstract | Publisher Full Text 7. Enver N, Doruk C, Sormaz IC, et al. : Awareness of Thyroid Surgeons on Voice and Airway Complications: An Attitude Survey in Turkey. Journal of voice: official journal of the Voice Foundation. 2021; 35 (1): 129–135. Epub 2019/09/04. PubMed Abstract | Publisher Full Text 8. Thorsen RT, Døssing H, Bonnema SJ, et al. : The Impact of Post-Thyroidectomy Neck Stretching Exercises on Neck Discomfort, Pressure Symptoms, Voice and Quality of Life: A Randomized Controlled Trial. World J. Surg. 2022; 46 (9): 2212–22. Epub 2022/06/01. PubMed Abstract | Publisher Full Text | Free Full Text 9. Graham BL, Steenbruggen I, Miller MR, et al. : Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am. J. Respir. Crit. Care Med. 2019; 200 (8): e70–e88. Epub 2019/10/16. PubMed Abstract | Publisher Full Text | Free Full Text 10. Moffatt DC, Tucker J, Goldenberg D: Management of compression symptoms of thyroid goiters: Hemithyroidectomy is equally as successful as total thyroidectomy. Am. J. Otolaryngol. 2023; 44 (1): 103676. Epub 2022/10/25. PubMed Abstract | Publisher Full Text 11. Cramon P, Bonnema SJ, Bjorner JB, et al. : Quality of life in patients with benign nontoxic goiter: impact of disease and treatment response, and comparison with the general population. Thyroid: official journal of the American Thyroid Association. 2015; 25 (3): 284–291. Epub 2015/01/21. PubMed Abstract | Publisher Full Text 12. Menon SK, Jagtap VS, Sarathi V, et al. : Prevalence of upper airway obstruction in patients with apparently asymptomatic euthyroid multi nodular goitre. Indian journal of endocrinology and metabolism. 2011; 15 (Suppl 2): 127–31. Epub 2011/10/04. PubMed Abstract | Publisher Full Text | Free Full Text 13. Stevens JL, Constantinides V, Todd J, et al. : Do flow volume loops alter surgical management in patients with a goitre?. Clin. Endocrinol. 2014; 81 (6): 916–920. Epub 2014/07/06. PubMed Abstract | Publisher Full Text 14. Ghai A, Hooda S, Wadherra R, et al. : Gross tracheal deviation: airway challenges and concerns--two case reports. Acta Anaesthesiol. Belg. 2011; 62 (4): 203–6. Epub 2011/01/01. PubMed Abstract 15. Bablekos GD, Roussou T, Rasmussen T, et al. : Postoperative changes on pulmonary function after laparoscopic and open cholecystectomy. Hepato-Gastroenterology. 2003; 50 (53): 1193–200. Epub 2003/10/24. PubMed Abstract 16. Katiyar N, Negi S, Negi SL, et al. : Assessment of factors affecting short-term pulmonary functions following cardiac surgery: A prospective observational study. Asian Cardiovasc. Thorac. Ann. 2022; 30 (2): 156–163. Epub 2021/04/16. PubMed Abstract | Publisher Full Text 17. Seok Y, Jheon S, Cho S: Serial changes in pulmonary function after video-assisted thoracic surgery lobectomy in lung cancer patients. Thorac. Cardiovasc. Surg. 2014; 62 (2): 133–139. Epub 2013/04/27. PubMed Abstract | Publisher Full Text 18. Wani KA, Dar HA, Malik AA, et al. : Comparison of postoperative pulmonary function tests after cholecystectomy performed through Kocher's incision and mini-incision. Int. Surg. 2002; 87 (2): 94–8. Epub 2002/09/12. PubMed Abstract 19. Dhillon G, Buddhavarapu VS, Grewal H, et al. : Evidence-based Practice Interventions for Reducing Postoperative Pulmonary Complications: A Narrative Review. Open Respir. Med. J. 2023; 17 : e18743064271499. Epub 2024/04/24. PubMed Abstract | Publisher Full Text | Free Full Text 20. Sullivan KA, Churchill IF, Hylton DA, et al. : Use of Incentive Spirometry in Adults following Cardiac, Thoracic, and Upper Abdominal Surgery to Prevent Post-Operative Pulmonary Complications: A Systematic Review and Meta-Analysis. Respiration; international review of thoracic diseases. 2021; 100 (11): 1114–1127. Epub 2021/07/19. PubMed Abstract | Publisher Full Text 21. Liaqat N: Immediate Effects of Thyroid Surgery on Pulmonary Dynamics of Upper Airway: A Preoperative and Postoperative Comparison Using Flow Volume Loop and Spirometry. OSF. 2025. osf.io/hs94a. Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 25 Mar 2025 ADD YOUR COMMENT Comment Author details Author details 1 Otorhinolaryngology, Head & Neck Surgery, Khyber Teaching Hospital, MTI, Peshawar, Khyber Pakhtunkhwa, Pakistan 2 Hayatabad Medical Complex, MTI, Peshawar, Khyber Pakhtunkhwa, Pakistan 3 Otorhinolaryngology, Head & Neck Surgery, Omdurman Military Hospital, Khartoum, Sudan Nazneen Liaqat Roles: Conceptualization, Formal Analysis, Project Administration, Software, Writing – Original Draft Preparation Izhar Ahmad Roles: Data Curation, Investigation, Methodology Zeeshan Ali Roles: Formal Analysis, Software, Writing – Original Draft Preparation, Writing – Review & Editing Israr Ud Din Roles: Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing Junaid Aziz Qadri Roles: Conceptualization, Data Curation, Resources, Writing – Original Draft Preparation Marwa Ibrahim Widatalla Abdalla Roles: Formal Analysis, Software, Writing – Original Draft Preparation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 25 Mar 2025, 14:323 https://doi.org/10.12688/f1000research.162645.1 Copyright © 2025 Liaqat N et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Liaqat N, Ahmad I, Ali Z et al. Immediate effects of thyroid surgery on pulmonary dynamics of upper airway: A preoperative and postoperative comparison using flow volume loop and spirometry [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :323 ( https://doi.org/10.12688/f1000research.162645.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 25 Mar 2025 Views 0 Cite How to cite this report: Mulita F. Reviewer Report For: Immediate effects of thyroid surgery on pulmonary dynamics of upper airway: A preoperative and postoperative comparison using flow volume loop and spirometry [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :323 ( https://doi.org/10.5256/f1000research.178882.r376076 ) The direct URL for this report is: https://f1000research.com/articles/14-323/v1#referee-response-376076 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 08 Apr 2025 Francesk Mulita , General University Hospital of Patras, Patras, Greece Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.178882.r376076 Summary The manuscript is a very appealing topic. The overall quality of the manuscript is good. A more detailed language revision should be conducted. Abstract The abstract is concise. All the necessary information about ... Continue reading READ ALL Summary The manuscript is a very appealing topic. The overall quality of the manuscript is good. A more detailed language revision should be conducted. Abstract The abstract is concise. All the necessary information about the study is included. Introduction - The information provided in this section is valuable for the comprehension of the manuscript. - The objective of the study is clearly mentioned in the last paragraph. Methods - The study design is well explained. - The inclusion and exclusion criteria are correctly mentioned. Results - The results are presented in an extensive way. - The tables are really helpful and necessary for the completion of the authors work. Discussion - The discussion is of good quality and includes updated data. - The authors inform extensively the reader about the study limitations. Conclusion From the presented data, the conclusion is complete and represents the work that the authors did. minor revision - The information provided in the introduction is important for the comprehension of the article. - The objective of the study is clearly mentioned. "The thyroid gland, consisting of two connected lobes, is one of the largest endocrine glands in the human body, weighing 20 - 30 g in adults. Thyroid lesions are often found on the gland, with a prevalence of 4%–7%. Most of them are asymptomatic, and thyroid hormone secretion is normal." I would suggest adding this information in the introduction section and consider citing the recently published article: [Ref 1] - The discussion is of great quality and includes updated data. - The authors should inform the reader about the study's limitations. I would like a brief discussion on the Bethesda classification system for reporting thyroid cytopathology ( especially for type II and III) and consider citing the recently published articles on Bethesda II and III: [Ref 2 and 3] What is the percentage of incidental malignancy according to these studies for Bethesda II and III? Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes References 1. Mulita F, Anjum F: Thyroid Adenoma. PubMed Abstract 2. Mulita F, Plachouri MK, Liolis E, Vailas M, et al.: Patient outcomes following surgical management of thyroid nodules classified as Bethesda category III (AUS/FLUS). Endokrynol Pol . 2021; 72 (2): 143-144 PubMed Abstract | Publisher Full Text 3. Mulita F, Iliopoulos F, Tsilivigkos C, Tchabashvili L, et al.: Cancer rate of Bethesda category II thyroid nodules. Med Glas (Zenica) . 2022; 19 (1). PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: thyroid surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Mulita F. Reviewer Report For: Immediate effects of thyroid surgery on pulmonary dynamics of upper airway: A preoperative and postoperative comparison using flow volume loop and spirometry [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :323 ( https://doi.org/10.5256/f1000research.178882.r376076 ) The direct URL for this report is: https://f1000research.com/articles/14-323/v1#referee-response-376076 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 25 Mar 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 25 Mar 25 read Francesk Mulita , General University Hospital of Patras, Patras, Greece Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Mulita F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The author(s) is/are employees of the US Government and therefore domestic copyright protection in USA does not apply to this work. The work may be protected under the copyright laws of other jurisdictions when used in those jurisdictions. 08 Apr 2025 | for Version 1 Francesk Mulita , General University Hospital of Patras, Patras, Greece 0 Views copyright © 2025 Mulita F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The author(s) is/are employees of the US Government and therefore domestic copyright protection in USA does not apply to this work. The work may be protected under the copyright laws of other jurisdictions when used in those jurisdictions. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Summary The manuscript is a very appealing topic. The overall quality of the manuscript is good. A more detailed language revision should be conducted. Abstract The abstract is concise. All the necessary information about the study is included. Introduction - The information provided in this section is valuable for the comprehension of the manuscript. - The objective of the study is clearly mentioned in the last paragraph. Methods - The study design is well explained. - The inclusion and exclusion criteria are correctly mentioned. Results - The results are presented in an extensive way. - The tables are really helpful and necessary for the completion of the authors work. Discussion - The discussion is of good quality and includes updated data. - The authors inform extensively the reader about the study limitations. Conclusion From the presented data, the conclusion is complete and represents the work that the authors did. minor revision - The information provided in the introduction is important for the comprehension of the article. - The objective of the study is clearly mentioned. "The thyroid gland, consisting of two connected lobes, is one of the largest endocrine glands in the human body, weighing 20 - 30 g in adults. Thyroid lesions are often found on the gland, with a prevalence of 4%–7%. Most of them are asymptomatic, and thyroid hormone secretion is normal." I would suggest adding this information in the introduction section and consider citing the recently published article: [Ref 1] - The discussion is of great quality and includes updated data. - The authors should inform the reader about the study's limitations. I would like a brief discussion on the Bethesda classification system for reporting thyroid cytopathology ( especially for type II and III) and consider citing the recently published articles on Bethesda II and III: [Ref 2 and 3] What is the percentage of incidental malignancy according to these studies for Bethesda II and III? Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes References 1. Mulita F, Anjum F: Thyroid Adenoma. PubMed Abstract 2. Mulita F, Plachouri MK, Liolis E, Vailas M, et al.: Patient outcomes following surgical management of thyroid nodules classified as Bethesda category III (AUS/FLUS). Endokrynol Pol . 2021; 72 (2): 143-144 PubMed Abstract | Publisher Full Text 3. Mulita F, Iliopoulos F, Tsilivigkos C, Tchabashvili L, et al.: Cancer rate of Bethesda category II thyroid nodules. Med Glas (Zenica) . 2022; 19 (1). PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise thyroid surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Mulita F. Peer Review Report For: Immediate effects of thyroid surgery on pulmonary dynamics of upper airway: A preoperative and postoperative comparison using flow volume loop and spirometry [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :323 ( https://doi.org/10.5256/f1000research.178882.r376076) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-323/v1#referee-response-376076 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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