Retrosternal thyroid goiter: 15 years experience.
BACKGROUND
Thyroidectomy for goiter is a common surgical procedure performed in most hospitals in Israel. Both general and ear, nose and throat surgeons are familiar with thyroidectomy for cervical goiters. In about 1-15% of thyroidectomies, the goiter is intrathoracic and requires somewhat different management. This topic has not been reviewed in the literature recently.


OBJECTIVE
To evaluate the clinical presentation, preoperative workup, surgical complications and risk of malignancy in retrosternal goiters.


METHODS
We retrospectively reviewed the records of 75 patients who underwent thyroidectomy for retrosternal goiter in the General Thoracic Surgical Department of our institution during a 15 year period, January 1990 to January 2005.


RESULTS
All the patients (41 women and 34 men) were symptomatic at presentation, with choking and dyspnea being the most common complaint. Computerized tomography scan of the neck and chest were obtained before the operation in 71 patients (95%). Ten patients (13%) had a previous partial thyroidectomy. A cervical approach was used in 68 patients (91%). Seven patients (9%) required median sternotomy to complete the operation. One patient (1.3%) died from postoperative respiratory failure. Transient recurrent laryngeal nerve palsy occurred in 5 patients (7%) and permanent RLNP in 3 (4%). The incidence of transient and permanent hypoparathyroidism was 10% and 2.6% respectively. Sixty-six lesions (88%) were benign and 9 (12%) were malignant.


CONCLUSIONS
Choking and dyspnea are the most common presenting symptoms of retrosternal goiter. CT scan is an important component of the preoperative evaluation and operative planning. Surgical removal of the thyroid is the treatment of choice and most patients have symptomatic improvement following the operation. Since a substernal thyroidectomy may be technically different from cervical thyroidectomy, a surgical team familiar with its unique pitfalls should perform the procedure.
Ben Nun
Alon
A
Department of General Thoracic Surgery, Rambam Medical Center, Haifa, Israel. a_ben_nun@rambam.health.gov.il
Soudack
Michalle
M
Best
Lael-Anson
LA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction; D004417:Dyspnea; D005260:Female; D006045:Goiter, Substernal / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed