Surgical approach to the intrathoracic goiter

Vaiman, Michael; Bekerman, Inessa; Jabarin, Basel; Peer, Michael

doi:10.1002/lio2.146

Cited by 8 publications

(16 citation statements)

References 29 publications

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“…Studies have reported mean weights of MNG to be 100-120 g and up to 180 g for cases of retrosternal extension. [10][11][12] Retrosternal extension rates vary depending on definition and classification. Recently, literature involving large case series place the true rate to be between 4.9% and 12.9%.…”

Section: Discussionmentioning

confidence: 99%

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Ethnic disparities for thyroid surgery

Ebrahim

2020

ANZ Journal of Surgery

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Background: Significant health disparities exist between M aori and non-M aori patients in New Zealand. M aori patients treated medically for their thyroid disease are less likely to be euthyroid. The prevalence of thyroid disease and characteristics of M aori presenting for thyroid surgery has not been well studied. We aim to assess the differences in ethnic representation for thyroid surgery. Methods: A retrospective analysis of cases performed between 2009 and 2019 at the Otolaryngology/Head and Neck Department in Waikato District Health Board (DHB) was completed. All patients who received a thyroid operation were included and divided into M aori and non-M aori groups. Clinical and operation notes were reviewed and the duration of presenting symptoms, weight, volume and diagnosis of the thyroid gland were assessed. Results: A total of 93 patients were included in our study, of whom 71 patients were female and 22 male with 37 being M aori and 56 non-M aori. M aori patients had significantly higher rates of retrosternal extension, compressive symptoms, post-operative complications, delayed presentation and larger thyroid goitres when compared to non-M aori (P < 0.05). Conclusion: Our study confirms that there is a significant ethnic disparity for M aori patients requiring thyroid surgery. This highlights an additional poor health outcome for M aori compared to non-M aori patients.

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Section: Discussionmentioning

confidence: 99%

“…The size and weight of a MNG vary significantly globally due to difference in practice, regional and demographic variations. Studies have reported mean weights of MNG to be 100–120 g and up to 180 g for cases of retrosternal extension 10–12 . Retrosternal extension rates vary depending on definition and classification.…”

Section: Discussionmentioning

confidence: 99%

Ethnic disparities for thyroid surgery

Ebrahim

2020

ANZ Journal of Surgery

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“…These lesions are much vascularized and are adjacent to large vascular structures; for it is necessary to anticipate bleeding taking into account the possible difficulties in intubation and ventilation secondary to the distortion of the upper airway, in the pre-anesthetic assessment. 11 Most cases are euthyroid. In the presence of a toxic goiter, radioactive iodine treatment can be performed in patients with high surgical risk who are not candidates for the interventions described.…”

Section: Discussionmentioning

confidence: 99%

Giant Intrathoracic Goiter of Atypical Presentation: A Case Report

Iriarte

Morales

Velásquez

et al. 2020

Clin Med�Insights�Pathol

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Background: The term goiter is used to describe any abnormal growth of the thyroid gland, which can be diffuse or nodular, and can be associated with normal, diminished, or increased thyroid function. Multinodular goiter is a common disease whose prevalence increases at age 50. Clinical manifestations can be due to thyroid function impairment or related to size and location of the gland with compressive symptoms. Intrathoracic location is less frequent, can be mistaken with pulmonary lesions and usually implies a difficult surgical approach. Case presentation: A 66-year-old woman with a history of subtotal thyroidectomy presented with 7-month dyspnea, dry cough. There was no evidence of neck masses, or jugular engorgement. Physical examination was normal. Chest x-ray showed an 11 cm mass in the upper right hemithorax. Computed tomography (CT)-scan, showed calcifications, and compression of the superior vena cava without infiltration, the right subclavian vein and left displacement of the trachea. Distinction between intrapulmonary or mediastinal location was not clear. Biopsy showed thyroid origin, and bilateral thoracotomy was performed with confirmation of a giant multinodular goiter. Conclusions: Intrathoracic goiter should undergo surgical or ablative management if compressive symptoms of the airway and cervical or thoracic vessels are present. The large size of the tumor along with the presentation after thyroidectomy and the seeming location in the right upper lobe made this particular case striking. Specially in the elderly, multidisciplinary perioperative management is key for a successful recovery.

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“…The frequency of ITG is differently appreciated because their definition is not univocal. 1 The incidence appears to be declining, particularly in developed countries, due to iodized salt consumption; early diagnosis and treatment of cervical goiters. 2,3 Two types of ITG can be distinguished: secondary goiter (95-99% of the ITG) and primary or ectopic or autonomous goiter.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of intrathoracic goiters: 20 years experience

et al. 2020

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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.

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Surgical approach to the intrathoracic goiter

Cited by 8 publications

References 29 publications

Ethnic disparities for thyroid surgery

Ethnic disparities for thyroid surgery

Giant Intrathoracic Goiter of Atypical Presentation: A Case Report

Surgical management of intrathoracic goiters: 20 years experience

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