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Linhares SM, Scola WH, Remer LF, Farrá JC, Lew JI. Morbidity Associated With Surgical Removal of Substernal Thyroid Goiters. J Surg Res 2022; 277:254-260. [DOI: 10.1016/j.jss.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 03/09/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022]
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2
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Linhares SM, Scola WH, Remer LF, Khan ZF, Nguyen DM, Lew JI. Depth of mediastinal extension can predict sternotomy need for substernal thyroid goiters. Surgery 2022; 172:1373-1378. [PMID: 36031445 DOI: 10.1016/j.surg.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/08/2022] [Accepted: 06/23/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Surgical excision of substernal thyroid goiters is usually achieved through a conventional transcervical approach, and transthoracic excision is rarely necessary. Currently, there are no clear guidelines for substernal thyroid goiters that may require a transthoracic approach. This study examined what preoperative factors were significantly associated with transthoracic surgical excision for substernal thyroid goiters. METHODS A retrospective review of prospectively collected data of 109 patients with substernal thyroid goiters from a single institution was performed. The patients were stratified by transcervical and transthoracic approaches for substernal thyroid goiters. The factors possibly predictive of a transthoracic approach, including substernal extension beyond the thoracic inlet, patient-reported symptoms, tracheal deviation, and malignancy, were analyzed. Demographics including age, sex, and race, among others, were also studied. RESULTS Of 1,080 patients who underwent surgical resection for multinodular goiter, there were 109 (10%) patients with substernal thyroid goiters. Of the substernal thyroid goiter group, 11 (10%) patients underwent partial sternotomy, whereas 6 (5.5%) underwent total sternotomy. On logistic regression, only substernal component of the thyroid goiter extending beyond the sternal notch into the mediastinum was statistically significant in predicting sternotomy (odds ratio 3.43, confidence interval 1.65-6.41, P < .001). Substernal thyroid goiters with mediastinal extension of ≥5 cm beyond the sternal notch showed a sensitivity of 94% and specificity of 86.5% to predict need of sternotomy. CONCLUSION Patients with substernal thyroid goiters who exhibit progressive enlargement and/or compressive symptoms should undergo surgical excision. Although most are removed through the conventional transcervical approach, substernal thyroid goiters with a depth of mediastinal extension ≥5 cm have a high likelihood of requiring sternotomy.
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Affiliation(s)
- Samantha M Linhares
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL.
| | - William H Scola
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
| | - Lindsay F Remer
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
| | - Zahra F Khan
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
| | - Dao M Nguyen
- Division of Thoracic Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
| | - John I Lew
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
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Zamora E, Ghandili S, Zamora MA, Chun KJ. Incidental Primary Intrathoracic Goiter: Dual-Isotope Scintigraphy and Early-MIBI SPECT/CT. World J Nucl Med 2022; 21:148-151. [PMID: 35865156 PMCID: PMC9296245 DOI: 10.1055/s-0042-1750337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Primary intrathoracic goiter is an uncommon congenital entity resulting from over decent ectopic thyroid tissue. As compared with secondary intrathoracic goiter, primary entities are discrete from orthotopic thyroid tissue and may lead to potentially serious complications such as malignancy and shortness of breath. Intrathoracic goiters have been described as showing mild or absent uptake of
99m
Tc-pertechnetate on planar scintigraphy. We present an incidental primary intrathoracic goiter found in a patient undergoing evaluation with multimodal scintigraphy and early
99m
Tc-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) for localization of parathyroid adenomas. The mass was inconspicuous on TcO
4-
scintigraphy but methoxyisobutylisonitrile-avid on early planar and SPECT/CT.
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Affiliation(s)
- E. Zamora
- Department of Radiology, Division of Nuclear Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States
| | - S. Ghandili
- Department of Radiology, Division of Nuclear Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States
| | - M. A. Zamora
- Sonoscan, Centro de Diagnóstico Biomédico, Guatemala City, Guatemala
| | - K. J. Chun
- Department of Radiology, Division of Nuclear Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States
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Kardi A, Oueslati I, Yazidi M, Sadok Boudaya M, Znaidi N, Chihaoui M. Hyperthyroidism secondary to a primary mediastinal goiter with normal functional cervical thyroid gland. Clin Case Rep 2021; 9:e05167. [PMID: 34917377 PMCID: PMC8645173 DOI: 10.1002/ccr3.5167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/18/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022] Open
Abstract
Primary mediastinal goiter is extremely uncommon. The majority of primary mediastinal goiters were reported as incidental findings on chest imaging of asymptomatic patients. Symptoms related to compression of adjacent structures or hyperthyroidism were rarely described. Herein we report a case of hyperthyroidism secondary to a primary mediastinal goiter.
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Affiliation(s)
- Asma Kardi
- Department of EndocrinologyFaculty of MedicineLa Rabta University HospitalUniversity of Tunis‐El ManarTunisTunisia
| | - Ibtissem Oueslati
- Department of EndocrinologyFaculty of MedicineLa Rabta University HospitalUniversity of Tunis‐El ManarTunisTunisia
| | - Meriem Yazidi
- Department of EndocrinologyFaculty of MedicineLa Rabta University HospitalUniversity of Tunis‐El ManarTunisTunisia
| | - Mohamed Sadok Boudaya
- Department of SurgeryFaculty of MedicineCharles Nicolle University HospitalUniversity of Tunis‐El ManarTunisTunisia
| | - Nadia Znaidi
- Laboratory of PathologyFaculty of MedicineCharles Nicolle University HospitalUniversity of Tunis‐El ManarTunisTunisia
| | - Melika Chihaoui
- Department of EndocrinologyFaculty of MedicineLa Rabta University HospitalUniversity of Tunis‐El ManarTunisTunisia
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5
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Sengul D, Sengul I, Ozturk T. Sutureless Thyroidectomy With Intraoperative Neuromonitoring and Energy-Based Device Without Sternotomy for Symptomatic Substernal Goiter Harboring Thyroiditis of Gland Parenchyma. Cureus 2021; 13:e16258. [PMID: 34277302 PMCID: PMC8269993 DOI: 10.7759/cureus.16258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/09/2022] Open
Abstract
Since substernal goiter first being described by Haller in 1749, a consensus on the definition of this entity has not been ensured, yet. Despite substernal goiter or retrosternal goiter is delineated as an enlarged thyroid gland with a component extending into the mediastinum, at least 10 definitions have described being able to depict the most accurate definition for substernal goiter. Of note, no consensus still has been declared on the therapeutic management of asymptomatic substernal goiter. It should be pointed out that, the American Association of Endocrine Surgeons (AAES), Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults reported approximately 9% to 13% of substernal goiters are being harbored thyroid malignancy. The following vignette case describes the clinical features of a symptomatic substernal goiter with chronic lymphocytic thyroiditis, her treatment by sutureless total thyroidectomy with intermittent-intraoperative neural monitoring (I-IONM), and the energy-based device without sternotomy, and the response of an adult who presented with a family history of malignant histopathology, differentiated thyroid carcinoma, which was exposed to the postoperative radioactive iodine ablation. We may recommend dividing the branches of superior thyroid arteries and the superior thyroid veins individually and exploring the fibrous Ligament of Berry, the true Ligament of Berry, with its safe interrelation to the inferior laryngeal nerve, finically, which may be regarded as different peas in a pod in a complete sutureless thyroidectomy for substernal goiter with thyroiditis in thyroidology.
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Affiliation(s)
- Demet Sengul
- Pathology, Giresun University Faculty of Medicine, Giresun, TUR
| | - Ilker Sengul
- Endocrine Surgery/General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Tuncer Ozturk
- General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
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6
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Oh SL, Chia CLK, Ooi OC, Sonawane V, Rao AD, Singaporewalla R. A rare case of ectopic retrosternal goiter. Clin Case Rep 2021; 9:1849-1852. [PMID: 33936601 PMCID: PMC8077326 DOI: 10.1002/ccr3.3610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/19/2020] [Accepted: 06/07/2020] [Indexed: 11/25/2022] Open
Abstract
It is important for the clinician to be familiar with interpreting a variety of radiological modalities that provide vital information that will aid in the preoperative planning, counseling, and subsequent management of patients with retrosternal goiter.
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Affiliation(s)
- Shen Leong Oh
- Department of General SurgeryKhoo Teck Puat HospitalSingaporeSingapore
| | | | - Oon Cheong Ooi
- Department of Cardiac, Thoracic and Vascular SurgeryNational University Heart HospitalSingaporeSingapore
| | - Vikram Sonawane
- Department of EndocrinologyKhoo Teck Puat HospitalSingaporeSingapore
| | - Anil D. Rao
- Department of General SurgeryKhoo Teck Puat HospitalSingaporeSingapore
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Iriarte MB, Morales EI, Velásquez M, Zúñiga V, Sua LF, Fernández-Trujillo L. Giant Intrathoracic Goiter of Atypical Presentation: A Case Report. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2020; 13:2632010X20916741. [PMID: 32363342 PMCID: PMC7180302 DOI: 10.1177/2632010x20916741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 03/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The term goiter is used to describe any abnormal growth of the thyroid gland, which can be diffuse or nodular, and can be associated with normal, diminished, or increased thyroid function. Multinodular goiter is a common disease whose prevalence increases at age 50. Clinical manifestations can be due to thyroid function impairment or related to size and location of the gland with compressive symptoms. Intrathoracic location is less frequent, can be mistaken with pulmonary lesions and usually implies a difficult surgical approach. CASE PRESENTATION A 66-year-old woman with a history of subtotal thyroidectomy presented with 7-month dyspnea, dry cough. There was no evidence of neck masses, or jugular engorgement. Physical examination was normal. Chest x-ray showed an 11 cm mass in the upper right hemithorax. Computed tomography (CT)-scan, showed calcifications, and compression of the superior vena cava without infiltration, the right subclavian vein and left displacement of the trachea. Distinction between intrapulmonary or mediastinal location was not clear. Biopsy showed thyroid origin, and bilateral thoracotomy was performed with confirmation of a giant multinodular goiter. CONCLUSIONS Intrathoracic goiter should undergo surgical or ablative management if compressive symptoms of the airway and cervical or thoracic vessels are present. The large size of the tumor along with the presentation after thyroidectomy and the seeming location in the right upper lobe made this particular case striking. Specially in the elderly, multidisciplinary perioperative management is key for a successful recovery.
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Affiliation(s)
| | - Eliana I. Morales
- Faculty of Health Sciences, Universidad
Icesi, Cali, Colombia
- Department of Internal Medicine,
Pulmonology Service, Fundación Valle del Lili, Cali, Colombia
| | - Mauricio Velásquez
- Faculty of Health Sciences, Universidad
Icesi, Cali, Colombia
- Departament of Surgery, Thoracic Surgery
Service, Fundación Valle del Lili. Cali, Colombia
| | - Valeria Zúñiga
- Clinical Research Center, Fundación
Valle del Lili, Cali, Colombia
| | - Luz F. Sua
- Faculty of Health Sciences, Universidad
Icesi, Cali, Colombia
- Departament of Pathology and Laboratory
Medicine, Fundación Valle del Lili, Cali, Colombia
| | - Liliana Fernández-Trujillo
- Faculty of Health Sciences, Universidad
Icesi, Cali, Colombia
- Department of Internal Medicine,
Pulmonology Service, Interventional Pulmonology, Fundación Valle del Lili, Cali,
Colombia
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8
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Maeda R, Tomita M, Oguri N, Ayabe T, Nakamura K. Primary ectopic mediastinal goiter. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04889-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Theurer S, Siebolts U, Lorenz K, Dralle H, Schmid KW. [Ectopic tissue of the thyroid gland and the parathyroid glands]. DER PATHOLOGE 2019; 39:379-389. [PMID: 30105609 DOI: 10.1007/s00292-018-0467-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Ectopic thyroid tissue results from developmental defects of the early stages of thyroid embryogenesis, in which the median thyroid anlage descends from the floor of the mouth to its final pre-tracheal position. The most common sites of ectopic thyroid tissue are accordingly in the area of the floor of the mouth and in the course of the thyroglossal duct. Rare localizations are intrathoracic (mediastinal, cardiac, pulmonary) and sub-diaphragmatic (including the adrenals, liver, gall bladder, and gastrointestinal tract). The most important differential diagnosis of ectopic thyroid is metastasis of differentiated thyroid carcinoma.By contrast, the term parathyroidectopy is not uniformly defined. Usually, the cervical-central localizations are referred to as "positional variants" (with the exception of the maxillary sinus and high parapharyngeal), whereas the cervical-lateral localizations (carotid sheath, vagus nerve) and those below the brachiocephalic and mediastinal positions (extraligamentary, aortopulmonary window, paravagal) and other rare localizations are classified as "ectopic parathyroid tissue". Parathyroidectomy is very common (in autopsy studies in 28 to 42.8% of all humans). In the context of primary hyperparathyroidism (pHPT), there is a prevalence of 6.3 to 16% of ectopic hyperfunctional parathyroid tissue (predominantly adenomas), which play an important role in the surgical treatment of pHPT.
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Affiliation(s)
- S Theurer
- Institut für Pathologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - U Siebolts
- Institut für Pathologie, Universitätsklinikum Halle, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - K Lorenz
- Klinik und Poliklinik für Viszeral‑, Gefäß- und Endokrine Chirurgie, Universitätsklinikum Halle, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - H Dralle
- Klinik für Allgemeinchirurgie, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - K W Schmid
- Institut für Pathologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
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10
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Surgical management of intrathoracic goitres. Eur Arch Otorhinolaryngol 2018; 276:305-314. [PMID: 30506185 DOI: 10.1007/s00405-018-5213-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 11/16/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Intrathoracic goitres (ITG) often present with compressive symptoms and require specialised care by experienced surgical teams. Most ITG can be accessed by a transcervical approach (TCA) and only between 1 and 15% will require an extracervical approach (ECA). Many controversies exist regarding the clinical presentation, evaluation, selection of cases for ECA, surgical technique and outcomes. This paper reviews the recent literature on the management, outcomes and evidence-based treatment strategies of ITG. METHODS We conducted a review of the literature on the evaluation, management and outcomes of surgery for ITGs. RESULTS The incidence of cancer in the ITGs ranges between 4 and 20%. Multiplanar CT scanning offers the best preoperative evaluation and aids to determine the approach. Most ITG can be accessed by TCA and ECA are only needed in maximum 15% of cases. In experienced hands, the outcome of these surgeries is comparable to thyroid surgery for non-ITG. CONCLUSIONS Surgery for ITG is challenging. The experienced surgeon however, with few exceptions can address ITG via TCA, with outcomes comparable to those of uncomplicated thyroid surgery.
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Abstract
Ectopic thyroid tissue is very rare, but its prevalence increases in those with thyroid pathology. It typically occurs due to aberrant development of the thyroid gland during its migration to the pretracheal region. In this report, there are two cases of mediastinal ectopic thyroid tissue discussed, which were initially considered to be malignancies. The hospital course, diagnostic workup, including the use of computed tomography and positron emission tomography scans, and the characteristic features of the tissue are examined here. Due to the imaging characteristics, it is important to consider ectopic thyroid tissue as a differential diagnosis for mediastinal masses as encountered in these cases. Asymptomatic ectopic thyroid tissue is usually treated medically; however, patients in both of our cases opted for surgical resection of the masses even after confirmation of the origin of the tissues.
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Affiliation(s)
- Yazdan Raji
- Department of Radiology and Imaging, The Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Supriya Gupta
- Department of Radiology and Imaging, The Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Darko Pucar
- Department of Radiology and Imaging, The Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Jayanth H Keshavamurthy
- Department of Radiology and Imaging, The Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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12
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Advanced vessel sealing devices in total thyroidectomy for substernal goitre: A retrospective cohort study. Int J Surg 2016; 35:160-164. [DOI: 10.1016/j.ijsu.2016.09.092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/31/2016] [Accepted: 09/24/2016] [Indexed: 02/03/2023]
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13
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Zhao H, Ren D, Liu Y, Li X, Wu Y, Chen G, Chen J. Complete transthoracic resection of giant posterior mediastinal goiter: case report and review of surgical strategies. Onco Targets Ther 2016; 9:2415-9. [PMID: 27217766 PMCID: PMC4853146 DOI: 10.2147/ott.s95352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Intrathoracic goiters generally occupy anterior mediastinum, rarely involving the posterior mediastinal space. Reported herein is a 54-year-old female with a giant posterior mediastinal mass that was successfully resected via right posterolateral thoracotomy. The final pathologic diagnosis was giant posterior mediastinal goiter. This patient has done well postoperatively, with no evidence of local recurrence at 12-month follow-up. Related surgical strategies in past publications are summarized.
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Affiliation(s)
- Honglin Zhao
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Dian Ren
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Yi Liu
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Xin Li
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Yi Wu
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Gang Chen
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
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Al Hashemy A, Gallo R, Shah MT, Al Faifi A, Al Amir A, Al Shraim M, Ezzat N, Rabie ME. Giant intrathoracic goitre: The challenges. INTERNATIONAL JOURNAL OF SURGERY OPEN 2016. [DOI: 10.1016/j.ijso.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Rolighed L, Rønning H, Christiansen P. Sternotomy for substernal goiter: retrospective study of 52 operations. Langenbecks Arch Surg 2015; 400:301-6. [DOI: 10.1007/s00423-015-1288-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 02/08/2015] [Indexed: 11/24/2022]
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16
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Oueriachi FE, Hammoumi MME, Arsalane A, Slaoui O, Diouri H, Kabiri EH. Primary mediastinal goiters. SPRINGERPLUS 2014; 3:503. [PMID: 25279295 PMCID: PMC4167882 DOI: 10.1186/2193-1801-3-503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/29/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary mediastinal goiters (PMG) are very uncommon; few cases were reported in the literature. PATIENT DESCRIPTION We report here two cases of mediastinal goiters that met all criteria of PMG. Transternal approach was necessary for complete removal and pathological diagnoses confirmed their adenomatous goiter nature. The rarity of their occurrence, their clinical characteristics and surgical management were discussed. CONCLUSION PMG is part of the differential diagnoses of mediastinal masses. Safe excision is ensured through transthoracic approach.
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Affiliation(s)
- Fayçal El Oueriachi
- Department of thoracic surgery, Mohamed V Military Teaching Hospital, Appt 15, Imm 18, Jnane Nahda, Hay Nahda, Rabat, Morocco
| | - Mohamed Massine El Hammoumi
- Department of thoracic surgery, Mohamed V Military Teaching Hospital, Appt 15, Imm 18, Jnane Nahda, Hay Nahda, Rabat, Morocco
| | - Adil Arsalane
- Department of thoracic surgery, Mohamed V Military Teaching Hospital, Appt 15, Imm 18, Jnane Nahda, Hay Nahda, Rabat, Morocco
| | - Omar Slaoui
- Department of thoracic surgery, Mohamed V Military Teaching Hospital, Appt 15, Imm 18, Jnane Nahda, Hay Nahda, Rabat, Morocco
| | - Hicham Diouri
- Department of thoracic surgery, Mohamed V Military Teaching Hospital, Appt 15, Imm 18, Jnane Nahda, Hay Nahda, Rabat, Morocco
| | - El Hassane Kabiri
- Department of thoracic surgery, Mohamed V Military Teaching Hospital, Appt 15, Imm 18, Jnane Nahda, Hay Nahda, Rabat, Morocco
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Surgical management of mediastinal goiter in the elderly. Int J Surg 2014; 12 Suppl 2:S148-S152. [PMID: 25157987 DOI: 10.1016/j.ijsu.2014.08.360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 11/21/2022]
Abstract
AIM Mediastinal goiter (MG) is characterized by compression symptoms such choking, dyspnea, sleeping apnea and dysphagia. It is significantly observed in elderly patients who due to comorbidity are associated to increased surgical risk. Total thyroidectomy is indicated to treat tracheal compression. Cervicotomy is the most used surgical access. AIM of the study was the evaluation of the role of surgery in the treatment of MG in the elderly. METHODS A retrospective analysis of twenty-eight-years on 1721 (390 over 80-years-old) cases of MG in a referral center for endocrine surgery was carried out. CT was used as a standard in the preoperative study. Surgery was performed by an experienced surgical team with standard technique via cervical approach or in selected cases via sternotomy or thoracotomy. Clinical records were examined. RESULTS Patients were divided into two groups: older and younger than 80-years-old. Total thyroidectomy was performed in all cases and via a cervical approach in almost 99% of patients. Tracheal dislocation and tracheomalacia were prevalent in elderly patients and were treated conservatively. Benign struma was observed in 1463 patients and a carcinoma in 258. Larger thyroid weight was observed in the elderly. The rate of complications was similar between groups. CONCLUSION Total thyroidectomy via cervical approach is the treatment of choice for MG in the elderly. It should be treated only in referral centers with adequate caution for elderly patients to achieve complete cure with limited complications.
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18
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Chen X, Xu H, Ni Y, Sun K, Li W. Complete excision of a giant thyroid goiter in posterior mediastinum. J Cardiothorac Surg 2013; 8:207. [PMID: 24196135 PMCID: PMC3826527 DOI: 10.1186/1749-8090-8-207] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 10/30/2013] [Indexed: 12/04/2022] Open
Abstract
Intrathoracic goiter is commonly located in the anterior mediastinum. Here we report a case of a 58-year-old Chinese male in whom we successfully removed the intrathoracic goiter and eased his dyspnea by a right posterolateral thoracotomy approach. Posterior mediastinal thyroid goiter with mediastinal compressive symptoms is an indication of surgery.
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Affiliation(s)
| | | | | | | | - Weidong Li
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Qing Chun Road 79#, Hangzhou, China.
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Naraynsingh V, Ramarine I, Cawich SO, Maharaj R, Dan D. Cervical leverage: A new procedure to deliver deep retrosternal goitres without thoracotomy. Int J Surg Case Rep 2013; 4:992-6. [PMID: 24076566 PMCID: PMC3825995 DOI: 10.1016/j.ijscr.2013.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 08/07/2013] [Accepted: 08/26/2013] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Although most retrosternal goitres can be removed through a standard collar incision, some cases require extra-cervical incisions for complete resection. We report a new technique to remove large retrosternal goitres without extra-cervical incisions. PRESENTATION OF CASE We present two cases in which a US Army-Navy (Parker-Langenback) retractor was used to deliver large retrosternal components into the cervical incisions. DISCUSSION This technique is useful in cases where the retrosternal component extends beyond the reach of the exploring finger and a well-developed plane can be developed between the gland and surrounding tissue. CONCLUSION The cervical leverage technique allows removal of a large retrosternal component through a cervical incision, thereby avoiding the attendant morbidity of a thoracotomy or median sternotomy. It should not be used if there is suspected neoplastic disease, dense adherence to or invasion of surrounding intra-thoracic structures.
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Affiliation(s)
- Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago
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Abstract
A combination of cardiac surgery and thyroidectomy as a single stage operation has rarely been reported in the literature. We report on the management of a 64-year-old female undergoing a combined aortic valve replacement and excision of a primary (ectopic) intrathoracic goiter. The literature on combined cardiac surgery and thyroidectomy is also reviewed.
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Affiliation(s)
- Annika Sjoeholm
- Department of Cardiothoracic Surgery, Dunedin Hospital, Dunedin, New Zealand
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Kanzaki R, Higashiyama M, Oda K, Okami J, Maeda J, Takenaka A, Tomita Y, Kodama K. Surgical management of primary intrathoracic goiters. Gen Thorac Cardiovasc Surg 2012; 60:171-4. [PMID: 22419189 DOI: 10.1007/s11748-011-0801-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 02/28/2011] [Indexed: 10/28/2022]
Abstract
Intrathoracic goiters account for 3.1%-5.8% of all mediastinal masses. Primary intrathoracic goiters, which receive their blood supply from mediastinal vessels and disconnect at the cervical thyroid, are even rarer. This report presents two cases of surgical resection of benign and malignant primary intrathoracic goiters. Usefulness of a whole-body (18)F-fluorine-2-fluoro-D: -glucose positron emission tomography/computed tomography study and intraoperative fine-needle aspiration cytology in the management of primary intrathoracic goiters is discussed.
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Affiliation(s)
- Ryu Kanzaki
- Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, Japan.
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Barker TA, Daultrey CR, Trotter SE, Kalkat M. Intrathymic primary intrathoracic goiter in a patient with breast malignancy. Ann Thorac Surg 2012; 93:e35-6. [PMID: 22269766 DOI: 10.1016/j.athoracsur.2011.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 09/12/2011] [Accepted: 09/19/2011] [Indexed: 10/14/2022]
Abstract
We report a rare case of an intrathymic primary intrathoracic goiter. The patient with newly diagnosed breast carcinoma was also known to have a distinct large anterior mediastinal mass. This was removed via a median sternotomy, after a thorascopic biopsy had been performed in the past but a diagnosis had not been reached. A discussion relating to the extremely rare occurrence of intrathymic ectopic thyroid tissue and the surgical treatment of primary intrathoracic goiters is included.
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Affiliation(s)
- Thomas A Barker
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
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Incidental Papillary Thyroid Carcinoma in a Patient Presenting With Graves' Hyperthyroidism and Concomitant Obstructive Sequestered Intrathoracic Multinodular Goiter. Clin Nucl Med 2011; 36:145-7. [DOI: 10.1097/rlu.0b013e318203bcc6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Marković V, Eterović D, Punda A, Brdar D, Roglić J, Slobodnjak Z. Retrotracheal secondary intrathoracic goiter presenting as cervical thyroid nodules on ultrasonography. Thyroid 2011; 21:91-2. [PMID: 21054239 DOI: 10.1089/thy.2010.0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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de Aguiar-Quevedo K, Cerón-Navarro J, Jordá-Aragón C, Pastor-Martínez E, Sales-Badia JG, García-Zarza A, Pastor-Guillén J. [Intrathoracic goitre: a literature review]. Cir Esp 2010; 88:142-5. [PMID: 20494348 DOI: 10.1016/j.ciresp.2010.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 12/02/2009] [Accepted: 03/16/2010] [Indexed: 10/19/2022]
Abstract
Intrathoracic goitre is defined as that goitre which is partially or totally found in the anterior or posterior mediastinum, and its incidence is associated with multinodular goitre. The diagnosis is relatively easy, mainly with imaging tests, and treatment varies, but of choice, surgical treatment is recommended. This article attempts to present a review of the literature on the diagnosis and management of this disease.
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Marcelino M, Nobre E, Conceição J, Lopes L, Vilar H, de Castro JJ. Superior vena cava syndrome and substernal goiter. Thyroid 2010; 20:235-6. [PMID: 20151836 DOI: 10.1089/thy.2009.0188] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Moschetta M, Ianora AAS, Testini M, Vacca M, Scardapane A, Angelelli G. Multidetector computed tomography in the preoperative evaluation of retrosternal goiters: a useful procedure for patients for whom magnetic resonance imaging is contraindicated. Thyroid 2010; 20:181-7. [PMID: 20151825 DOI: 10.1089/thy.2009.0107] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Diagnostic imaging provides useful anatomical and morphological information of cervico-mediastinal goiters. The aim of this study was to assess the usefulness of multidetector computed tomography (MDCT) with multiplanar reformatting and volume rendering reconstructions for the preoperative evaluation of retrosternal goiters in patients for whom magnetic resonance imaging is contraindicated. METHODS From March 2006 to January 2009, 34 patients (20 women and 14 men; mean age, 48 years; range, 42-74 years) with suspected cervico-mediastinal goiter were assessed by MDCT after intravenous injection of contrast material. The following parameters were evaluated: morphology, size, and enhancement of thyroid lobes; presence, location, and mediastinal extension of thyroid tissue; and relations with mediastinal vessels and organs. All patients underwent thyroidectomy. A reference group of 34 patients evaluated by single-detector computed tomography was created. The two groups of patients were compared searching for operative time (OT, in hours), hospital stay (HS, in days), and morbidity rate observed after thyroid surgery in all cases. RESULTS In 29/34 patients, thyroid was enlarged with left mediastinal extension in 12 cases, right extension in 10 cases, and posterior extension in 7 cases. In 3/34 patients, a normal cervical thyroid connected to the mediastinal goiter through a thin parenchymal stripe was observed. In 2/34 patients, thyroid lobes were enlarged, without mediastinal extension. By comparing the two groups of patients for OT and HS values, a significant reduction to 3.7 +/- 0.1 hours and 4.3 +/- 0.1 days, respectively, was found in the group of MDCT patients, and also a trend to the reduction for morbidity rate (21%) could be recognized. CONCLUSIONS MDCT represents a noninvasive tool in the evaluation of retrosternal goiters. High-quality multiplanar reformatting and volume rendering reconstructions allow an optimal analysis of the plunged gland and could reduce OT, HS, and probably the morbidity rate.
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Affiliation(s)
- Marco Moschetta
- Section of Radiology, Department of Internal Medicine and Public Medicine, University of Bari Medical School, Bari, Italy.
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