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At least 253 records · Page 14Linked to original sources
PubMed1998

Compression syndromes caused by substernal goitres.

Enlargement of the thyroid is common, especially in areas of endemic iodine deficiency. Substernal enlargement of a goitre can cause compression of several mediastinal structures. As a consequence of tracheal compression and tracheomalacia, syndromes of chronic respiratory distress occur and intercurrent upper respiratory infections may lead to acute respiratory failure. Superior vena cava syndrome secondary to compression by a substernal goitre may be complicated by venous thrombosis. Although dysphagia is the most frequent oesophageal symptom of a substernal goitre, upper gastrointestinal bleeding from 'downhill' oesophageal varices may be an initial presentation. Arterial compression or thyrocervical steal syndrome by large substernal goitres occasionally cause cerebral hypoperfusion and stroke. Recurrent and phrenic nerve palsies, as well as Horner's syndrome, occur secondary to non-malignant mediastinal goitres and may resolve after surgery. Substernal goitres rarely cause therapy-resistant pleural effusions, chylothorax and pericardial effusion. In conclusion, although cervical goitres are easily recognised, the initial presentation of mainly substernal goitres may be unusual.

Esophageal Stenosis↗
PubMed1990

Axillosubclavian vein thrombosis produced by retrosternal thyroid.

Several causes of axillosubclavian vein thrombosis have been described. Trauma to the subclavian vein by pacemaker wires or central venous lines as well as the so-called effort thrombosis have been recognized as frequently diagnosed precipitating factors. A patient is herein presented with thrombosis of the subclavian vein caused by a giant substernal thyroid compressing the innominate vein.

Axillary Vein↗
PubMed1989

Bilateral phrenic nerve palsy associated with benign thyroid goiter.

Phrenic nerve palsy secondary to benign thyroid enlargement is a previously unreported complication. Large goiters, particularly substernal, may impinge upon adjacent structures, often leading to significant symptoms such as dysphagia or dyspnea due to airway compression. The phrenic nerve may be stretched by a large goiter along its course in the neck, but the more likely site of injury is the point at which it enters the thoracic cavity adjacent to the first rib. Such an injury, caused by compression, may go unrecognized if unilateral, as symptoms would be uncommon. However, bilateral phrenic nerve palsy can cause significant dyspnea due to pulmonary insufficiency, particularly in an elderly patient with cardio-pulmonary disease. Early operative treatment of the goiter may prevent this complication or limit its severity, thus avoiding permanent nerve injury.

Aged↗
PubMed1992

Management of substernal goitre.

Goitres of the thyroid gland whose major component resides substernally would appear to have a different presentation and management protocol than those goitres that reside mainly in the neck. These goitres, as opposed to their supraclavicular counterparts, usually present with symptoms referrable to compression of the trachea or esophagus. Even in those patients who are asymptomatic, a precise history may elicit pertinent findings. Furthermore, these goitres do not respond to suppression and require surgical removal. The trans-cervical approach is the most desirable, but the surgeon must be willing to enter the chest on that rare occasion. We reviewed the charts of 938 patients undergoing thyroid surgery who were registered in the Head and Neck Tumour Registry of the University of Toronto. Approximately 2.4% of patients had substernal goitres. Their history, pathology and ultimate surgical management will be discussed.

Adult↗
PubMed2000

Substernal goitre: a rare cause of pulmonary hypertension and heart failure.

Benign substernal goitres usually extend into the upper anterior mediastinum and are easily extractable through a cervical approach. Very infrequently these tumours extend into the thoracic cavity causing compression of mediastinal structures. The authors report a case of pulmonary hypertension and severe cardiac failure secondary to a long-standing substernal goitre, and support the surgical management of this disease.

Aged↗
PubMed1994

Thyroidectomy in patients with marked thyroid enlargement: airway management, morbidity, and outcome.

The medical records of 91 patients who underwent thyroidectomy from 1990 to 1993 were reviewed to evaluate airway management and operative morbidity in patients with marked thyroid enlargement. Twenty-nine patients with marked thyroid enlargement were identified: 13 unilateral, defined by a weight of > or = 40 g (mean 122 g, range 41-380 g), and 16 bilateral, defined by a weight of > or = 80 g (mean 160 g, range 82-404 g). Twenty-five patients had compressive symptomatology, 18 had tracheal narrowing and/or displacement, 19 had substernal extension, and one had superior vena cava syndrome. Unilateral vocal cord dysfunction was present in two of three patients with carcinoma and one of 26 patients with benign disease (P = 0.03). Pathology consisted of nodular goiter (11), adenoma (5), carcinoma (3), Grave's disease (5), and toxic multinodular goiter (5). All patients had an uncomplicated endotracheal intubation without the use of a fiberoptic bronchoscope as predicted on the basis of preoperative laryngoscopic findings. Ease of intubation was unrelated to the extent of abnormality seen on imaging studies of the neck. Thyroidectomy alone was effective in relieving compressive symptoms with no incidence of nerve injury, permanent hypoparathyroidism, or tracheomalacia. Six (21%) of 29 patients had temporary hypocalcemia compared to eight (13%) of 62 patients with lesser thyroid enlargement (P = 0.36). One patient with an unresectable follicular carcinoma died from aspiration pneumonia three weeks following tracheostomy placement. Marked thyroid enlargement and upper airway compression is predominantly caused by benign disease; however, when there is associated recurrent laryngeal nerve dysfunction, carcinoma is more common.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed1983

Intrathoracic thyroid.

A case of intrathoracic or substernal thyroid is presented. The anatomical and radiological features and differential diagnoses are discussed.

Diagnosis, Differential↗
PubMed1988

[Roentgen image of the trachea in the supine position in substernal struma: a further possibility in avoiding radioiodine diagnosis].

It is recommended in substernal struma in the X-ray picture of the trachea prior to the X-ray picture in sitting position to make an X-ray picture in lying position, when the substernal part of the struma is not unequivocally to be seen in the 99mTc scintigram. Thus in many cases the discrepancy may be clarified and the radioiodine diagnostics be avoided.

Constriction, Pathologic↗
PubMed1988

Surgical management of substernal goitre.

This paper presents the clinical features and problems in the management of 34 patients with substernal goitre. Complete evaluation of the mediastinum relied on computed tomography. Thyroid function tests were performed routinely and showed a clinically underestimated incidence of hyperthyroidism (44 per cent). The incidence of occult malignancy in substernal goitres was high (12 per cent). In the majority of patients (88 per cent) the substernal goitres were removed by a collar incision. Four cases of goitres located in a retrotracheal position required a combined cervical and sternotomy approach. None of the 34 patients died. Transient postoperative hypocalcaemia was found in 41 per cent of our patients. The presence of a substernal goitre is an indication for resection based on the risk of malignancy, the risk of acute respiratory distress, the high incidence of thyrotoxicity and a low surgical morbidity.

Adult↗
PubMed1981

Superior vena caval syndrome in benign mediastinal goitre.

The superior vena caval syndrome is the clinical condition which develops at too high a pressure in the superior vena cava and the afferent veins. Its aetiology has changed in the course of time, but at present 97% of the cases are due to intrathoracic malignancy. An extremely rare aetiological factor is substernal and intrathoracic goitre. In such cases the syndrome is often of fairly acute onset due to haemorrhage in the goitre, and as a rule it is associated with dyspnoea and dysphagia. The treatment is always operative.

Aged↗