Abstract
A recurrent intrathoracic goiter and a case of intrathoracic goiter with tracheal narrowing are presented. The symptoms were mainly dyspnea and wheezing, but vascular compression is also a possible severe symptom. The importance of preoperative evaluation regarding the relation of the gland with the surrounding structures such as major vessels and trachea is emphasized. Although ultrasonography is the first step radiologic tool for cervical thyroid pathologies, non-contrast computerized tomography is the preferred method of radiologic evaluation. Valuable information about the extent of gland to the mediastinum and the compressive effect of the gland to the surrounding structures can be evaluated, and operative management can be planned in detail. Intubation of the patient with a tracheal stricture needs to be focused on. The alternatives are discussed on the case with low situated tracheal compression. Most of the intrathoracic goiters can be removed through a cervical incision. Hourglass-shaped goiters or intrathoracic goiters placed in the posterior mediastinum and malignant cases with possible invasions sometimes require a sternotomy or thoracotomy to remove the gland safely thorough vascular structures.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Rios A, Rodríguez J, Balsalobre M, Tebar F, Parrilla P. The value of various definitions of intrathoracic goiter for predicting intra-operative and postoperative complications. Surgery. 2010;147:233–8. https://doi.org/10.1016/j.surg.2009.06.018.
Walz P, Iwenofu O, Essig G. Ectopic mediastinal goiter successfully managed via cervical approach: case report and review of the literature. Head Neck. 2011;35:E94–7. https://doi.org/10.1002/hed.21920.
Katlic M, Wang C, Grillo H. Substernal goiter. Ann Thorac Surg. 1985;39:391–9.
Foroulis C, Rammos K, Sileli M, Papakonstantinou C. Primary intrathoracic goiter: a rare and potentially serious entity. Thyroid. 2009;19:213–8. https://doi.org/10.1089/thy.2008.0222.
Anders H. Compression syndromes caused by substernal goitres. Postgrad Med J. 1998;74:327–9.
Qureishi A, Garas G, Tolley N, Palazzo F, Athanasiou T, Zacharakis E. Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre? Int J Surg. 2013;11:203–8. https://doi.org/10.1016/j.ijsu.2013.01.006.
Al-Bazzaz F, Grillo H, Kazemi H. Response to exercise in upper airway obstruction. Am Rev Respir Dis. 1975;111(5):631–40. https://doi.org/10.1164/arrd.1975.111.5.631.
Nakaya M, Ito A, Mori A, Oka M, Omura S, Kida W, et al. Surgical treatment of substernal goiter: an analysis of 44 cases. Auris Nasus Larynx. 2017;44:111–5. https://doi.org/10.1016/j.anl.2016.02.016.
Tan P, Esa N. Anesthesia for massive retrosternal goiter with severe intrathoracic tracheal narrowing: the challenges imposed -a case report. Korean J Anesthesiol. 2012;62:474. https://doi.org/10.4097/kjae.2012.62.5.474.
Wong P, Chieh Liew G, Kothandan H. Anaesthesia for goitre surgery: a review. Proc Singap Healthc. 2015;24:165–70. https://doi.org/10.1177/2010105815596095.
Huins C, Georgalas C, Mehrzad H, Tolley N. A new classification system for retrosternal goitre based on a systematic review of its complications and management. Int J Surg. 2008;6:71–6. https://doi.org/10.1016/j.ijsu.2007.02.003.
Wang L. Surgical management of a substernal goiter. Formosan J Surg. 2012;45:41–4. https://doi.org/10.1016/j.fjs.2012.02.001.
Nankee L, Chen H, Schneider D, Sippel R, Elfenbein D. Substernal goiter: when is a sternotomy required? J Surg Res. 2015;199:121–5. https://doi.org/10.1016/j.jss.2015.04.045.
Khan M, Goljo E, Owen R, Park R, Yao M, Miles B. Retrosternal Goiter: 30-day morbidity and mortality in the transcervical and transthoracic approaches. Otolaryngol Head Neck Surg. 2016;155:568–74. https://doi.org/10.1177/0194599816649583.
Testini M, Gurrado A, Bellantone R, Brazzarola P, Cortese R, De Toma G, et al. Recurrent laryngeal nerve palsy and substernal goiter. An Italian multicenter study. J Visc Surg. 2014;151:183–9. https://doi.org/10.1016/j.jviscsurg.2014.04.006.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Emre, A.U. (2019). Intrathoracic Goiter. In: Özülker, T., Adaş, M., Günay, S. (eds) Thyroid and Parathyroid Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-78476-2_22
Download citation
DOI: https://doi.org/10.1007/978-3-319-78476-2_22
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-78475-5
Online ISBN: 978-3-319-78476-2
eBook Packages: MedicineMedicine (R0)