Substernal goiter

Newman, Elliot; Shaha, Ashok R.

doi:10.1002/jso.2930600313

Cited by 126 publications

(90 citation statements)

References 17 publications

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“…Literature reports often stress the need for surgical treatment in relation to compressive symptoms, potential airway compromise, and the possibility of an association with thyroid malignancy. [2][3][4][5][6] The mediastinal thyroid can be usually managed through a cervical incision. 7 This approach has been shown to be sufficient in up to 97% of cases.…”

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Preoperative predictors of sternotomy need in mediastinal goiter management

et al. 2010

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Background. The objective of this study was to identify the preoperative risk factors for patients in need of a sternotomy in the management of mediastinal goiters in order to provide better preoperative planning and patient consent.Methods. We analyzed 98 patients who underwent surgery for mediastinal goiters (goiters extending below the thoracic inlet 3 cm with the neck in hyperextension) between 1995 and 2008. Twelve (12.2%) of the patients required a sternotomy. The patients' features were analyzed by the surgical approach performed. Logistic regression analysis was used to study which variables were influencing the surgical strategy. The receiver operating characteristic (ROC) curves were designed when appropriate.Results. Terms such as retrosternal, substernal, intrathoracic, or mediastinal have been used to describe a goiter that extends beyond the thoracic inlet. Although suppression therapy by exogenous thyroxine can reduce the size of the gland by 20% to 30%, 1 the consensus is that the mediastinal goiter is a condition that requires surgical management. Literature reports often stress the need for surgical treatment in relation to compressive symptoms, potential airway compromise, and the possibility of an association with thyroid malignancy. 2-6The mediastinal thyroid can be usually managed through a cervical incision. 7 This approach has been shown to be sufficient in up to 97% of cases. 5 In patients in whom the gland cannot be safely removed through a cervical incision, thyroidectomy may require a thoracic approach to gain adequate exposure and to remove the gland while avoiding dangerous tractions. Unfortunately, there is no clear demarcation of the cases that require a combined approach, and the Correspondence to: G. Pata

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confidence: 99%

Preoperative predictors of sternotomy need in mediastinal goiter management

et al. 2010

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“…Although medical suppression of retrosternal goiter has been described, this is a temporary and cure can be achieved only with surgery (Katlic et al, 1995;Newman and Shaha, 1995). The aim of the present study was to highlight the epidemiology, clinical features, surgical approach, complications and incidence of malignancy in retrosternal goiter.…”

Section: Introductionmentioning

confidence: 85%

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2016

Int. J. Curr. Res. Biosci. Plant Biol

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A b s t r a c t A r t i c l e I n f oThe aim of the study was to highlight the epidemiology, clinical features and surgical complications of retrosternal goiter. All patients operated for thyroid disease during the period from June 1999 to January 2009 in the Surgical Department of 7 th October Hospital, Benghazi-Libya were retrospectively analyzed and age, sex and clinical features were noted. Out of 3614 thyroidectomies performed, 97 patients were found to have retosternal goiter (2.7%). The mean age was 42 yrs (25-80 yrs). 81 (83%) patients were females and (17%) 16 patients were males. (93%) 90 patients were euthyroid, (5%) 5 patients were toxic and (2%) and 2 patients were hypothyroid. About one Seventh of the patients were asymptomatic. Commonly observed symptoms were, shortness of breath, hoarseness, dysphagia, cough and superior vena cava obstruction. In all patients the goiter was resected through cervical incision, except three patients who needed partial sternotomy. Total thyroidectomy was performed in (72%) 70 cases. There were four minor complications and no death. The incidence of retrosternal goiter with respect to thyroidectomy patients is (2.7%). Cervical incision is nearly always adequate. Retrosternal goiter doesn't seem to be associated with increased incidence of post-operative complications.

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“…Although the vast majority of retrosternal goiters can be excised adequately and safely via a cervical approach, thoracic exposure is required for these indications: (1) recurrent intrathoracic goiter, (2) previous mediastinal or cardiothoracic surgery, (3) previous radiation to the neck or mediastinum, (4) malignant tumor abutting the great vessels, (5) isolated intrathoracic goiter, and (6) retrotracheal goiter extending below the level of the carina [1]. Median sternotomy allows careful identification of the lower extent of the goiter and its relationship to the great vessels.…”

Section: Large Goiter and Retrosternal Extensionmentioning

confidence: 99%

Surgery for Thyroid Cancer

Gil¹,

Patel²

2008

Surgical Oncology Clinics of North America

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Surgical resection of the thyroid gland is standard treatment for management of carcinomas and is performed by a variety of specialists, including general surgeons, otolaryngologists, endocrine surgeons, and oncologic surgeons. Oncologic thyroid surgery has three main objectives: to assure complete removal of one or both of the thyroid lobes, to preserve the parathyroid (PT) glands and their blood supply, and to prevent injury to the superior and recurrent laryngeal nerves (RLNs). To perform safe and efficient thyroid surgery, surgeons should be familiar not only with the anatomy of the thyroid gland and the vital structures along the course of the gland but also with the anatomic variations in regional anatomy. Although postoperative complications are infrequent in experienced hands, hypocalcemia and vocal cord paralysis can lead to significant morbidity and impaired quality of life. The operation of thyroidectomy has been performed for more than a century [1] and is well described in the literature with the expected variation in the actual technique of the procedure.This article describes the technique of thyroidectomy in detail as practiced by the authors at Memorial Sloan-Kettering Cancer Center for the surgical treatment of thyroid cancer. A technique that facilitates complete extracapsular resection of the thyroid, preserves the PT glands with their blood supply, the RLNs, and the superior laryngeal nerves, and minimizes postoperative complications is emphasized. Management of certain specific situations, such as retrosternal goiter, locally invasive thyroid cancer, and reoperative surgery for locally recurrent cancer, is discussed but management of the regional lymph nodes is not addressed here. Standard surgical technique of thyroidectomyThe extent of surgical resection of the thyroid gland for well-differentiated thyroid cancer (WDTC) has been debated extensively and the indications and pros and cons of hemiversus total thyroidectomy are discussed in the article by Witt elsewhere in this issue. The authors practice a policy of risk stratification in deciding the extent of surgery, and the

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Substernal goiter

Cited by 126 publications

References 17 publications

Preoperative predictors of sternotomy need in mediastinal goiter management

Preoperative predictors of sternotomy need in mediastinal goiter management

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Surgery for Thyroid Cancer

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