The “forgotten” goiter after total thyroidectomy

Şahbaz, Alper; Aksakal, Nihat; Özçınar, Beyza; Onuray, Feyyaz; Çağlayan, Kasım; Erbil, Yeşim

doi:10.1016/j.ijscr.2012.11.014

Cited by 20 publications

(29 citation statements)

References 5 publications

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“…Also, according to Sacket et al (6) classification, rest tissues can be missed during total thyroidectomy due to the permanence between thyroid tissue and the 3 rd and 4 th grade remnants, which constitute 20% of the remnants. It can be prevented if particular attention is paid to preopera-tive imaging and intraoperative management during the first operation (2,7). Thus, routine dissection of pretracheal area and seeing thymus in the thoracic inlet should be a part of every total thyroidectomy that is performed due to nodular goiter.…”

Section: Discussionmentioning

confidence: 99%

“…"Missed gland" is the substernal portion of thyroid that can be defined as thyroid formation with cervical departure that goes beyond the superior thoracic strait for at least 3 cm and is connected to the cervical portion of thyroid with or without a thin fibrous band or vascular structure, which is forgotten after total thyroidectomy (1,2).…”

Section: Introductionmentioning

confidence: 99%

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Missed thyroid gland after total thyroidectomy

et al. 2018

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Missed gland is an extremely rare condition. It is a mediastinal thyroid mass found after total thyroidectomy. We report a case of missed gland. The patient underwent total thyroidectomy due to multinodular goiter and thyroid stimulating hormone levels did not increase after surgery. Pathological tests revealed a micropapillary carcinoma. Thyroid ultrasonography and scintigraphy scan revealed mediastinal thyroid mass. The patient underwent redo surgery without sternotomy and there was no morbidity after the second surgical procedure. Most missed thyroid gland cases are due to incomplete removal of plunging thyroid goiter during total thyroidectomy. They also can be attributed to a concomitant, unrecognized mediastinal goiter, which is not connected to the thyroid gland with vessels or a thin fibrous band. It should be noted that absence of signs like mediastinal mass or tracheal deviation in preoperative chest X-ray does not exclude substernal goiter. The presence of a missed thyroid gland should be kept in mind when postoperative thyroid stimulating hormone levels remain unchanged.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Missed thyroid gland after total thyroidectomy

et al. 2018

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“…However, retrosternal goiter incidence rates range between 0.2% and 45% of all goiters, depending on the definition used. About 20-40% of retrosternal goiters are symptomatic (6). Respiratory symptoms and rarely dysphagia or vena cava superior syndrome may be seen in some cases (2).…”

Section: Discussionmentioning

confidence: 99%

“…However, thoracotomy or sternotomy is usually needed for surgical excision of mediastinal thyroid tissue (2). Surgical treatment for forgotten goiter, when performed in specialized centers, is associated with low morbidity (6). In this patient, ectopic thyroid tissue was excised through median sternotomy.…”

Section: Discussionmentioning

confidence: 99%

Missed retrosternal ectopic thyroid tissue in a patient operated for multinodular goiter

Kesici

Koral

Kesi̇ci̇

et al. 2016

UCD

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Missed retrosternal ectopic thyroid tissue in a patient operated for multinodular goiter INTRODUCTIONEctopic thyroid tissue is a common abnormality due to the abnormal embryological development and migration of thyroid tissue. Ectopic thyroid tissue is commonly seen in the midline of the neck throughout the descending pathway of the thyroid gland (1). Ectopic thyroid tissue can be found from the tongue to the diaphragm. Ectopic thyroid tissue is usually seen in the tongue, submandibular region, cervical lymph nodes, larynx, trachea, oesophagus, mediastinum, diaphragm and heart respectively (2, 3). Although the most common type of ectopic thyroid tissue is lingual, the most common non-cervical location is the thoracic cavity (1). "Forgotten goiter" is an extremely rare situation which is described as a mediastinal thyroid mass found after total thyroidectomy (4).In this article, a case report of a patient with retrosternal ectopic thyroid tissue detected after total thyroidectomy, is presented. CASE PRESENTATIONWe obtained consent from the patient for publication of this case report. In this case report, we discussed a 49 year-old female patient whose retrosternal ectopic thyroid tissue was detected by thyroid scintigraphy taken in postoperative period after total thyroidectomy performed with diagnosis of multinodular goiter. Approximately 3-4 years of swelling and pinching sensation was present on the neck in the anamnesis of the patient who was followed due to multinodular goiter. Palpable nodules were present in both thyroid lobes in physical examination of the patient. Palpable lymph nodes were not present in the neck in physical examination. The right lobe of the thyroid gland was 6 x 2 x 2 cm, the left lobe was 7 x 2.5 x 2 cm and the thickness of isthmus was 1 cm in the neck ultrasonography (USG) of the patient. There were no pathological lymph nodes. Multiple nodules, the largest being over 4 cm on the right (hypoechoic, irregular edged with peripheral halo), were detected in both thyroid lobes in the neck USG of the patient. It was decided to perform total thyroidectomy to the patient. Preoperative blood examinations, chest X-ray and thyroid function tests of the patient were normal. Total thyroidectomy was performed to the patient under general anesthesia. Nineteen milimeters diameter thyroid papillary carcinoma was detected in histopathological examination (capsule invasion and lenfovascular invasion were negative, without extrathyroidal spread).

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“…Sometimes the mediastinal goiter may not be in connection with the normally located gland, what makes the diagnosis and surgery even more difficult [12].…”

Section: Casementioning

confidence: 99%

The usefulness of SPECT/CT in characterization of skeletal and soft tissue lesions — report of two cases

et al. 2014

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SPECT/CT imaging provides detailed information on the radiotracer distribution and enables simultaneous lesion morphology evaluation.This hybrid imaging delivers complementary information about patient's disease.We present two cases in which SPECT/CT imaging and cooperation between the nuclear medicine physician and radiologist quickly clarified the diagnosis, sparing patient unnecessary diagnostic procedures or treatment.

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The “forgotten” goiter after total thyroidectomy

Abstract: Retrosternal goiter should be suspected if the lower poles could not be palpated on physical examination and when postoperative TSH levels remained unchanged.

Cited by 20 publications

References 5 publications

Missed thyroid gland after total thyroidectomy

Missed thyroid gland after total thyroidectomy

Missed retrosternal ectopic thyroid tissue in a patient operated for multinodular goiter

The usefulness of SPECT/CT in characterization of skeletal and soft tissue lesions — report of two cases

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