Tracheal or esophageal compression was present in 91 (33 percent) of 273 consecutive patients with benign goiter during a 7 year experience. The underlying disease was nodular colloid goiter in 66 percent, adenoma in 21 percent, thyroiditis in 9 percent and Graves' disease in 4 percent. The incidence of tracheoesophageal compression was higher in patients with thyroiditis (67 percent) than in those with colloid goiter (46 percent). Thirty of 91 patients were completely asymptomatic but had marked tracheal deviation on roentgenography. Two thirds presented with significant dyspnea, or dysphagia or both. A long history of goiter preceding the onset of symptoms and progressive worsening of compression symptoms after its onset were common in the latter group. Previous radiographs demonstrating significant tracheal deviation during a previous presymptomatic period were available in 11 of 36 dyspneic patients. Sudden tracheal occlusion developed in 3 percent and required emergency treatment. Tracheal compression occurred more often and when present was a more ominous symptom. Compression manifestations were more frequent in patients with multinodular goiter, were more likely to appear when the underlying disorder was thyroiditis affected the tracheal more often than the esophagus and were generally gradually progressive with time. A clinical spectrum ranging from a presymptomatic tracheal compression stage to one wherein progressive worsening of symptoms occurs is suggested. After symptoms of tracheal compression become clinically manifest, the occurrence of complete airway occlusion may be sudden and unpredictable. Early operation whenever roentgenographic evidence of tracheal deviation becomes manifest is recommended.
"Some of our patients, during the early phase of our study, underwent nuclear imaging (any specific indication for those undergoing nuclear imaging?), but neither nuclear imaging nor sonography is essential for the preoperative evaluation of known RSG. An esophagogram can confirm esophageal compression, but it does not add much to its management. "
[Show abstract][Hide abstract] ABSTRACT: Retrosternal goiter (RSG) is a term that has been used to describe a goiter that extends beyond the thoracic inlet. Surgery plays an important role in the treatment of these patients, but whether all or selected patients with RSG should undergo this operation remains controversial. Our aim is to look into the demographics, presentation, and treatment of patients with RSG and essentially to determine the role of surgery in its treatment.
Retrospective study, teaching hospital-based.
Retrospective analysis of 537 thyroidectomies performed at King Khalid University Hospital between 2003 and 2010. The twenty-six patients with RSG were analyzed further, with regard to demographics, presentation, indications, and outcome of surgical treatment. Statistical analysis was performed, where age was expressed as mean and range, and other variables were presented as numbers and percentage.
There were 26 patients (4.8%) with RSG out of 537 thyroidectomies, who underwent an operation for removal of RSGs, in a seven-year period. The most common presentation was dyspnea (34.6%) and the surgical procedure predominantly used was total thyroidectomy. The RSGs were removed by collar incision in 96% of the cases. The final histological diagnosis revealed malignancy in 26.9% of the thyroid specimens. There was no mortality and minor complications occurred in nine patients.
The presence of an RSG is an indication for surgery owing to the lack of effective medical treatment, the higher incidence of symptoms related to compression, low surgical morbidity, and the risk of malignancy.
[Show abstract][Hide abstract] ABSTRACT: The literature on substernal goiter from the seventeenth century to the present is reviewed. Substernal goiter may be defined as any thyroid enlargement that has its greater mass inferior to the thoracic inlet. Truly ectopic mediastinal goiters are rare, and most substernal goiters arise from and maintain some attachment to the cervical thyroid gland. Patients are generally in the fifth decade of life, and women predominate. Most patients experience dyspnea, stridor, or dysphagia, but 15 to 50% are asymptomatic; symptoms are often positional, and acute stridor may occur. Ten to twenty percent have no cervical mass or tracheal deviation on examination, and virtually all patients are euthyroid. Standard chest roentgenograms are often diagnostic, but computed tomographic or radioactive iodine scans may be helpful. The presence of a substernal goiter in all but the highest-risk patients is an indication for resection, usually through a cervical collar incision; an occasional patient will require sternotomy or thoracotomy. Death or major complications should be rare postoperatively. Substernal goiters are adenomatous and benign, but carcinoma occurs in 2 to 3% and may be occult. Patients should be followed closely, as these goiters may recur.
The Annals of Thoracic Surgery 05/1985; 39(4):391-9. DOI:10.1016/S0003-4975(10)62645-8 · 3.85 Impact Factor
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