title: [Management of thyroid goiters invading mediastinum and thoracic cavity].
abstract: OBJECTIVE
  To investigate the diagnosis and treatments of thyroid goiters invading mediastinum and thoracic cavity.
  
  
  METHODS
  Seventy-eight cases of thyroid goiters invading mediastinum and thoracic cavity and undergoing surgery from 1995 to 2005 were reviewed. There were 22 males and 56 females and their age ranged from 45 years to 78 years with a median age of 59 years. According to the classification of intrathoracic thyroid goiters, there were 50 cases in Class I, 20 cases in Class II and 8 cases in Class III. In these patients, 38 cases suffered from dyspnea at degree I and 20 cases at degree II. Of the patients, 71 underwent thyroidectomy through neck approach and 7 underwent thyroidectomy by a combined approach of neck incision plus sternotomy or lateral thoracotomy. Tracheal defects in 4 cases and esophageal defects in 3 cases were repaired. Postoperative residual diseases were found in tracheoesophageal wall (5 cases) and mediastinum (6 cases). Eleven patients received postoperative radiotherapy and 18 underwent (131)I treatment. No case died of operation and no case with wound infection.
  
  
  RESULTS
  The time of follow-up was 60 - 180 months with a median of 110 months. Three patients lost follow-up. Dyspnea in 58 cases were improved after operation. Three of 49 patients with nodular goiters died from cardiocerebrovascular diseases. Of 29 patients with thyroid papillary carcinoma, 2 died from lung metastasis and 3 died from neck relapse. Five-year survival rate was 75.0% in the patients with thyroid cancer.
  
  
  CONCLUSIONS
  Most of thyroid goiters invading mediastinum and thoracic cavity can be completely resected via neck approach, but a combined approach of neck incision plus sternotomy or lateral thoracotomy may be used in some cases with malignant goiters to dissect the diseases completely. Postoperative external beam radiotherapy are required for the residual diseases. (131)I may be considered in high-risk differentiated thyroid carcinoma cases.
authors.affiliation: Department of Head and Neck Surgery, Hunan Province Tumor Hospital, Changsha, China. chj2926@yahoo.com.cn
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.forename: Jian-jun
authors.initials: JJ
authors.lastname: Yu
authors.forename: Wei
authors.initials: W
authors.lastname: Wei
authors.forename: Zan
authors.initials: Z
authors.lastname: Li
authors.forename: Wen-xiao
authors.initials: WX
authors.lastname: Huang
authors.forename: Rong-hua
authors.initials: RH
authors.lastname: Bao
authors.forename: Li
authors.initials: L
authors.lastname: Xie
authors.forename: Jin-yun
authors.initials: JY
authors.lastname: Li
authors.forename: Hai-lin
authors.initials: HL
authors.lastname: Zhang
mesh_terms: D000368:Aged; D005260:Female; D006044:Goiter, Nodular / Q000473:pathology; D006045:Goiter, Substernal / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000628:therapy; D008875:Middle Aged; D012189:Retrospective Studies; D035423:Thoracic Cavity / Q000473:pathology; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*