A case of big substernal goiter resection

Abstract

Substernal goiter is considered to be a diagnostic differential for all anterosuperior mediastinal masses. For a substernal goiter, surgical removal is suggested when it is large in size, with a possibility for malignancy or has local compression of adjacent structures. This can be performed through the neck or by the addition of a partial or complete sternotomy if necessary. A 58-year-old Chinese man from Guangdong Province had had dry cough for a year. A subsequent CT scan in our hospital suggested “ectopic intrathoracic thyroid”. Fine needle percutaneous mass biopsy also suggested “ectopic intrathoracic thyroid”. We performed a standard median sternotomy to remove the mass. It measured 13 cm × 8 cm × 6 cm in size, and weighed 2.8 kg. The pathological diagnosis confirmed a benign thyroid adenoma. The patient had no hoarseness, dyspnea or hypocalcemia and was quickly extubated in the operating room. Recently, we encountered a big substernal goiter and had performed successful resection, which is reported here for reference.

References

1. Creswell L L, Wells S A . Mediastinal masses originatingin the neck. Chest Surg Clin N Am, 1992, 2(1): 23–55
2. Greenholz S K, Karrer F M, Lilly J R . Contemporary surgery of tracheomalacia. J Pediatr Surg, 1986, 21(6): 511–514. doi:10.1016/S0022-3468(86)80222-6
3. Blair G K, Cohen R, Filler R M . Treatment of tracheomalacia: eight years' experience. J Pediatr Surg, 1986, 21(9): 781–785. doi:10.1016/S0022-3468(86)80366-9
4. Sakorafas G H, Vlachos A, Tolumis G, Kassaras G A, Anagnostopoulos GK, Gorgogiannis D . Ectopic intrathoracic thyroid:case report, Mt Sinai J Med, 2004, 71(2): 131–133
5. Netterville J L, Coleman S C, Smith J C, Smith M M, Day T A, Burkey B B . Management of substernal goiter. Laryngoscope, 1998, 108(11 Pt 1): 1611–1617. doi:10.1097/00005537-199811000-00005
6. White M L, Doherty G M, Gauger P G . Evidence-based surgical management of substernal goiter. World J Surg, 2008, 32(7): 1285–1300. doi:10.1007/s00268-008-9466-3
7. Hedayati N, McHenry C R . The clinical presentationand operative management of nodular and diffuse substernal thyroiddisease. Am Surg, 2002, 68: 245–252
8. Adegboye V O, Ogunseinde O A, Obajimi M O, Ladipo J K, Brimmo A I . Pattern of intrathoracic goiter in Ibadan,Nigeria. Niger Postgrad Med J, 2002, 9(4): 226–232
9. Ignjatovic M, Stanic V, Cuk V, Kostic Z . Intrathoracicgoiter: analysis of 21 cases. Acta ChirIugosl, 2002, 49(1): 15–25
10. Tsukada H, Kojima K, Takeuchi S, Osada H . Intrathoracicretroesophageal goiter causing tracheal stenosis. Jpn J Thorac Cardiovasc Surg, 1999, 47(4): 174–177
11. Agha A, Glockzin G, Ghali N, Iesalnieks I, Schlitt H J . Surgical treatment of substernalgoiter: An analysis of 59 patients. SurgToday, 2008, 38(6): 505–511. doi:10.1007/s00595-007-3659-5
12. Leuchter I, Becker M, Mickel R, Dulguerov P . Horner'ssyndrome and thyroid neoplasms. ORL J OtorhinolaryngolRelat Spec, 2002, 64(1): 49–52
13. Houck W V, Kaplan A J, Reed C E, Cole D J . Intrathoracicaberrant thyroid: identification critical for appropriate operativeapproach. Am Surg, 1998, 64(4): 360–362
14. Maruotti R A, Zannini P, Viani M P, Voci C, Pezzuoli G . Surgical treatment of substernal goiters. Int Surg, 1991, 76(1): 12–17
15. Ben Nun A, Soudack M, Best L A . Retrosternal thyroid goiter: 15 years experience. Isr Med Assoc J, 2006, 8(2): 106–109
16. Rios A, Rodriguez J M, Canteras M, Galindo P J, Tebar F J, Parrilla P . Surgical management of multinodular goiter with compressionsymptoms. Arch Surg, 2005, 140(1): 49–53. doi:10.1001/archsurg.140.1.49
17. Maddaus M A, Pearson F G . Tracheomalacia.In Pearson FG et al ed. Thoracic Surgery. 2nd edition, New York, Churchill Livingstone, 2002, 320–325
18. Page C, Monet P, Peltier J, Bonnaire B, Strunski V . Non-recurrent laryngeal nerverelated to thyroid surgery: report of three cases. J Laryngol Otol, 2008, 122(7): 757–761. doi:10.1017/S0022215107008389
19. Nervi M, Iacconi P, Spinelli C, Janni A, Miccoli P . Thyroid carcinoma in intrathoracic goiter. Langenbecks Arch Surg, 1998, 383(5): 337–339. doi:10.1007/s004230050144
20. Pisanu A, Pili S, Uccheddu A . Non–recurrent inferior laryngeal nerve. Chir Ital, 2002, 54(1): 7–14