Posterior Mediastinal Goiter Removal Through Cervical Incision

Intrathoracic goiter when encountered can be treated by thyroidectomy using cervical incision, only occasionally requiring extra cervical approach. We are reporting one such case in a patient with pituitary macroadenoma with extension of the adenomatous goiter into the posterior mediastinum. It was removed through the cervical collar incision using a vessel sealing device. There were no intraoperative and postoperative complications during the procedure. The need for extra cervical incision should be decided on a case-to-case basis to avoid the increased morbidity associated with sternotomy and lateral thoracotomy incision.

Combined cervicosternotomy and cervicotomy for true retrosternal goiters: a surgical cohort study

Objective Intrathoracic goiters are a heterogeneous group characterized by limited or extensive substernal extension. Whereas the former can be treated through cervicotomy, the latter sometimes requires a cervicosternotomy. Whether cervicosternotomy leads to more morbidity remains unclear. This study aimed to compare intra- and postoperative morbidity in patients treated by cervicotomy or cervicosternotomy for intrathoracic goiters and standard thyroidectomy. Methods In a prospectively gathered cohort undergoing thyroid surgery (2010–2019) intra- and postoperative morbidity of cervicotomy (N = 80) and cervicosternotomy (N = 15) for intrathoracic goiters was compared to each other and to a ‘standard’ thyroidectomy (N = 1500). Results An intrathoracic extension prior to surgery was found in 95 (6%) of all thyroidectomies. Eighty patients (84%) were operated by cervicotomy and 15 (16%) by cervicosternotomy. The risk of temporary recurrent laryngeal nerve palsy was much higher in the cervicosternotomy group (21%) compared to cervicotomy (4%) and standard thyroidectomy (3%). The risk of temporary hypocalcemia after cervicotomy (28%) was comparable to a standard thyroidectomy (32%) but higher after cervicosternotomy (20%). No cases of permanent hypocalcemia or laryngeal nerve palsy were observed in both groups with substernal extension. The need for surgical reintervention was significantly higher in the cervicotomy group (6%) compared to cervicosternotomy (0%) and standard thyroidectomy (3%). Conclusion In patients undergoing thyroid surgery for an intrathoracic goiter, cervicosternotomy was associated with more temporary laryngeal nerve palsy, but none of the interventions resulted in higher risks of permanent nerve damage, permanent hypocalcemia, or reintervention for bleeding. Reintervention was even more common after cervicotomy compared to cervicosternotomy. Level of evidence IV

Top van de ijsberg: indrukwekkende intrathoracale goiter

Tip of the iceberg: massive intrathoracic goiter In this article a case of an 80 year-old man with an impressive intrathoracic goiter is described. Thorough evaluation of the structural and functional impact and the risk of malignancy is needed. Theoretically, the management can consist of surgical resection, radioactive iodine, anti-thyroid drugs (in case of hyperthyroidism), or active surveillance. Multidisciplinary consultation is essential in cases of goiter with an important intrathoracic component. Based on the absence of compressive problems, the mild hyperthyroidism, the low risk of thyroid cancer and the anticipated slow growth, an active surveillance strategy was chosen.

A Case of a Young Woman with Cervico-Mediastinal Malignant Goiter

The main treatment in nearly every case of thyroid cancer is surgery. The exception often refers to anaplastic carcinoma because this cancer is already widespread at the time of diagnosis. Most of the cases are treated with thyroidectomy, but small tumors that spread inside the thyroid gland might be treated by lobectomy. Intrathoracic goiter accounts for 5.8% of all mediastinal masses. On the other hand, the incidence of thyroid malignancy in cervico-mediastinal thyroid masses is 7,7%. In such cases, total thyroidectomy with en block removal of the mediastinal portion of the gland is the treatment of choice. We present a case of a 34-year-old woman with cervico-mediastinal malignant goiter.

Surgical management of intrathoracic goiters: 20 years experience

Background: Surgery is necessary for intrathoracic goiters (ITG) even in asymptomatic forms considering the risks of compression and malignancy. The major problem is the adequate approach. Intrathoracic goiter’s removal can be performed via a cervical approach, whereas sternotomy might be required intraoperatively in some cases.Methods: A retrospective analysis of twenty years on 122 cases of intrathoracic goiters in a referral centre for thoracic surgery was carried out. We included secondary substernal goiters and ectopic thoracic goiters.Our aim was to define the specifities of this surgery and its outcomes. Postoperative data were examined as well as morbidity and mortality factors.Results: The most common symptoms included dyspnea, cough and dysphagia. Whereas Twenty-two patients were asymptomatic. One hundred sixteen patients underwent a successful transcervical incision without thoracic approach. Six cases of primary goiters were noted, of whom 3 were extracted via a cervical approach. Two cases showed unilateral recurrent nerve paralysis and two cases a hypoparathyroidism.Conclusions: Surgical management of intrathoracic goiter was correlated with low morbidity and mortality The cervical approach was performed in the vast majority of cases without an extra cervical procedure. Intrathoracic approaches were restricted to some selected indications.

A Giant Intrathoracic Goiter

Intrathoracic goiter is a relatively rare benign finding, leading often to dyspnea and dysphagia. Imaging methods are of a great importance for the diagnosis. Surgery and total thyroidectomy are the treatment of choice. We present a case of a 72-year-old woman with dysphagia, shortness of breath and fatigue. We observed an increase in both thyroid lobes with retrosternal evolution, descending to the pulmonary artery to the right, and to the aortic arch to the left, with compression of the trachea, brachiocephalic veins and vena cava superior. We performed total thyroidectomy through combined cervical-anterior thoracic right-sided access. Surgical treatment for intrathoracic goiter with or without clinical symptoms is always indicated and should be performed as soon as possible.