Surgical management of mediastinal goiter in the elderly

Polistena, Andrea; Monacelli, Massimo; Lucchini, Roberta; Triola, Roberta; Conti, Claudia; Avenia, Stefano; Rondelli, Fabio; Bugiantella, Walter; Barillaro, Ivan; Sanguinetti, Alessandro; Avenia, Nicola

doi:10.1016/j.ijsu.2014.08.360

Cited by 14 publications

(28 citation statements)

References 19 publications

(18 reference statements)

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“…Although the thyroid malignant disease has a lower incidence in the elderly, we must remember that it represents the 30% of all thyroid disorders compared to 6-8% in younger subjects (11). Tracheal compression and thyrotoxicosis are frequent surgical indications in the elderly (12).…”

Section: Indications For Surgical Treatmentmentioning

confidence: 99%

Thyroidectomy in elderly patients aged ≥70 years

et al. 2017

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Worldwide, the indications for thyroid surgery have been continuously extended among elderly patients in the last 20 years. The balance between treatment indication and surgical risk is certainly an interesting topic for every thyroid surgeon. This paper is a review of recent literature from January 2005 up to April 2017. We analyzed three principal subjects: indications for surgical treatment, medical complications and surgical complications. We can summarize the conclusions of our analysis, stating that age could not be considered as an absolute factor, but in relation to the comorbidities and the general clinical condition of the patient. Special risk indices dedicated to geriatric patients could be very useful in order to facilitate the decision-making process; however, relying on the current knowledge, we could state that there is value in providing surgery to geriatric patients in highly specialized and high-volume centers, where access to technology and its systematic use, coupled with surgeons' experience, could certainly avail the geriatric patient management.

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Section: Indications For Surgical Treatmentmentioning

confidence: 99%

Thyroidectomy in elderly patients aged ≥70 years

et al. 2017

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“…The maneuver involves 'elevating both arms until they touch the sides of the head'; if the sign is present 'after a minute or so, congestion of the face, cyanosis, and lastly distress become apparent [13]. We detected moving up of the MG toward to neck when the neck of the patient had extension due to increased intrathoracic pressure, so became apparent in our patient [14][15][16].…”

Section: Discussionmentioning

confidence: 78%

A Mediastinal Goitre Case That Moving Upward To Neck during a Cystoperitoneal Shunting Operation

Küçükyıldız¹

2018

BJSTR

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Arachnoids cysts (AC) are non-tumoral and congenital lesions and constitute 1% of all intracranial space occupying lesions [1]. Ninety percent of ACs is located in the supratentorial region and 10% are in the posterior fosse [2]. The middle cranial fosse is the most common place of the ACs (60%) other sites include seller region, cerebral convexity, and quadrigeminal plate. The clinical signs and symptoms of ACs are relegated with their size, anatomic location and influence on the cerebrospinal fluid (CSF). Symptomatic ACs is usually diagnosed in the first or second decades of life due to increased intracranial pressure, craniomegaly or developmental delay. The definition of meditational goiter (MG) generally refers to a stoma with location for at least 50% of its volume in substernal position [3]. MG is a rare disease that generally diagnosed incidentally, and up to 40% of MGs are asymptomatic [4]. They may cause compressive symptoms in the surrounding tissues if they are large enough. Case ReportA sixtyeight year old right handed woman was admitted to our clinic with headache which increased for last six months and seizure complaintes. Physical examination of the patient's head, neck and abdomen were normal. Neurologic examination did not show any abnormalities. We check both the thyroid hormones and thyroid stimulation hormone levels routinely before operation and were normal. Computerized tomography (CT) and contrast enhanced magnetic resonance imaging (MRI) showed a 56x48x90 mm in size cytic lesion on the right occipital lobe of the brain which has very close relationship with the posterior pole of right lateral ventricle. The cyst did not enhanced after contrast media injection and reported as an AC. A right Cystoperitoneal shunting operation was planned. After entubation of the patient, a pillow was placed under the shoulders to provide extension to the neck.In a few minutes after positioning of the patient, a lump in 4x5 cm size appeared on the right anterolateral side of the neck, and the anesthesiologist said the patient had difficulty in ventilation. Ultra son graphic examination was performed in operating room and showed a nodule 43x66x78 mm in size which moved from right lobe of thyroid to the retrosternal region. The operation has cancelled, and position changed to normal which caused disappearing of the lesion. The patient extubated and detailed endocrinology and radiologic examination were planned. The patient consulted by general surgeon and they decided to operate the patient before cysto-peritoneal shunt operation.

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“…Sometimes thyroid mass not in direct connection with neck goiter, but present in mediastinum, separately encapsulated, as the case we described above. It should be removed at the time of initial excision of cervical thyroid to prevent reoperation later on and decreasing the risk of morbidity and mortality from the procedure [16]. Therefore, detailed examination and extensive imaging preoperatively keeping in mind the possibility of a separate retrosternal thyroid mass can result in better preoperative planning and patient counseling, hence further reducing the morbidity and risk of complications from the procedure.…”

Section: Discussionmentioning

confidence: 99%

Huge Dual Ectopic Retroternal Thyroid Masses within a Single Capsule: A Case Report

Elkahwagy¹,

Mogahed²,

Basalama³

et al. 2020

AJSCR

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Background: Goiter sometimes has retrosternal extension in the mediastinum. And may present with compressive symptoms such as dyspnea, dysphagia, dysphonia or sleep apnea. Treatment of choice is total thyroidectomy and removal of the intrathoracic portion of thyroid. However, these cervicomediastinal masses may be separately encapsulated, and a sternotomy may be required for complete and safe excision of the mediastinal mass to achieve decompression of the surrounding structures and preventing the hemorrhagic complications if attempted from cervical incision

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Surgical management of mediastinal goiter in the elderly

Abstract: Total thyroidectomy via cervical approach is the treatment of choice for MG in the elderly. It should be treated only in referral centers with adequate caution for elderly patients to achieve complete cure with limited complications.

Cited by 14 publications

References 19 publications

Thyroidectomy in elderly patients aged ≥70 years

Thyroidectomy in elderly patients aged ≥70 years

A Mediastinal Goitre Case That Moving Upward To Neck during a Cystoperitoneal Shunting Operation

Huge Dual Ectopic Retroternal Thyroid Masses within a Single Capsule: A Case Report

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