title: An unusual recurrent bilateral posterior mediastinal goiter after subtotal thyroidectomy: Case report.
abstract: BACKGROUND
  Surgical treatment of benign thyroid diseases need to be followed up closely, since recurrent thyroid nodules can be seen after subtotal thyroidectomy. Intrathoracic goiter (ITG) occurs in 10-30% of patients following subtotal thyroidectomy. In general these goiters are benign, having a malignant rate of only 2-22%. ITG grows slowly but steadily and in its process of development, it narrows the thoracic inlet by compressing the surrounding structures. Most of these can not located in the anterior mediastinum, others located in posterior retrovascular area. Bilateral posterior retrovascular goiters are very rare.
  
  
  METHODS
  We report a case involving a 61-year-old woman with history of gradual-onset dyspnea who was referred to us for evaluation of a large mediastinal mass. She had undergone bilateral thyroid lobectomy for a cervical goiter 10 years ago. The mass was removed successfully via median sternotomy without complication. The patient recovered well and was discharged in 1 week.
  
  
  CONCLUSIONS
  Most anterior mediastinal goiters can be resected through a transcervical approach, but if those extending beyond the aortic arch into the posterior mediastinum are better dealt with by sternotomy or lateral thoracotomy.
  
  
  CONCLUSIONS
  Bilateral recurrent posterior mediastinal and retrovascular large goiters are better resected via sternotomy rather than lateral thoracotomy. The reason for that are the possibility of injury to large vascular structures and the difficulty of their management through lateral thoracotomy when cardiopulmonary bypass needed.
authors: Adana Numune Training and Research Hospital Department of General Surgery, Adana and Kars State Hospital General Surgery, Turkey. Electronic address: mhmtaziret@gmail.com.
authors: Mehmet
authors: M
authors: Aziret
authors: Çukurova University, Department of Cardiovascular Surgery, Adana, Turkey.
authors: Mehmet Şah
authors: MŞ
authors: Topçuoğlu
authors: Çukurova University, Department of Surgery of Thoracic Surgery, Adana, Turkey.
authors: Cemal
authors: C
authors: Ozçelik
authors: Adana Numune Training and Research Hospital Department of Surgery of Thoracic Surgery, Adana, Turkey.
authors: Muharrem
authors: M
authors: Ozkaya
keywords: Intrathoracic goiter; Median sternotomy; Mediastinum