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PubMed1980

[Substernal goitre. Report of 45 cases (author's transl)].

Among 1,000 operated goiters excluding hyperthyroidism, 45 were compressives (4,5%). Epidemiologic factors were elderly patients, ancient unoperated goiters and recidivism of formerly operated goiters. 1. Prognosis is not hopeless since 60% of compressive goiters were benign. On the other hand, the 40% carcinoma growed swiftly, being either anaplastic or follicular but with local or metastatic extension. 2. Clinical aspect is of no use to ascertain benignity or malignity. Extemporaneous histological examination may be falsely reassuring; but the discovery of a carcinoma allows more appropriate operation. 3. In case of acute dyspnea, only tracheal intubation has to be done in emergency. Intubation is always possible. But the operation has to be done later in better technical conditions. Technique and errors to avoid are exposed in details. 4. Complications are scarce. Tracheomalacia never occured. But laryngeal edema or recurential palsy may need a few days intubation. Technical aspects in order to avoid compressive hematoma as well as sequelae are described.

Aged↗
PubMed1989

[Cervico-mediastinal goiter].

The descent of a cervical goiter below the plain of the thoracic inlet to become substernal in location, is fairly rare, but not exceptional, with an incidence, derived from several large series of operated patients, ranging from 1.7% to 13.1%. The importance of this particular location of the goiter is chiefly due to the fact that the thyroid is growing in a limited space with many surrounding structures, that unavoidably, sooner or later, will be compressed or strained. This provokes respiratory symptoms (such as cough, dyspnea, stridor) or difficulty in swallowing or determines a superior vena cava syndrome with venous stasis in the neck and in the upper thorax, and with facial oedema. The substernal location, that already constitutes a complication of the basic thyropathy, is further aggravated by the incidental malignant transformation of the substernal goiter or by the development of a thyrotoxicosis due to hyper-functioning intra-thoracic thyroid tissue. For all these reasons the presence of a substernal goiter represents in and of itself a precise indication for a surgical treatment. This study is aimed at examining the series of 19 substernal goiters observed at the Institution of General and Cardiovascular Surgery, University of Milan, from 1967 to 1987, particularly analyzing the progresses in the diagnostic procedures, the adopted surgical therapy and the observed complications.

Adult↗
PubMed2006

Primary intrathoracic goiter.

Nodular goiter is a common disease in Taiwan, and substernal or intrathoracic goiters are not infrequent. However, intrathoracic goiters are mainly of the secondary type and primary intrathoracic goiters are rarely seen. We report a 55-year-old woman who was incidentally found to have an ectopic goiter located in the anterior upper mediastinum with the initial presenting symptom of productive cough. Imaging studies including chest X-ray and computed tomography identified the lesion, and 131I-uptake scan showed weak uptake in the thorax. Surgical removal via thoracotomy was performed and the diagnosis was confirmed by pathology. A primary intrathoracic goiter, although rare, should also be considered in the differential diagnosis of mediastinal tumor.

Diagnosis, Differential↗