Clinical Presentation and Surgical Treatment of Retrosternal Goiter: A Case Series Study

Author:

Abdelrahman Husham1,Al-Thani Hassan2,Al-Sulaiti Maryam2,Tabeb Abdelhakem2,El-Menyar Ayman34

Affiliation:

1. Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar

2. Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar

3. Clinical Medicine, Weill Cornell Medical College, Doha, Qatar

4. Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital (HGH), Doha, Qatar

Abstract

Background: The retrosternal goiter (RSG) is a slow-growing mass often benign in nature; thyroidectomy remains the preferred standard curative treatment. This study aimed to explore the local experience of RSG with respect to the clinical presentation, classifications, management, and outcomes. Method: A retrospective chart review was conducted to include all cases diagnosed with RSG and underwent thyroidectomy between January 1998 and December 2013. Results: A total of 1210 patients underwent thyroidectomy; of which 30 (2.5%) patients were diagnosed to have RSG. The commonly reported symptoms were dyspnea (40%), pain and discomfort (30%), dysphagia (26.7%), and hoarseness (20%). Thirteen patients (43.3%) were completely asymptomatic. The fine-needle aspiration cytology was performed in 22 (73.3%) patients, of whom the majority was benign (77.3%). The grading classification showed that grade 1 is the most frequent (73.3%). Total bilateral thyroidectomy was the most prevailing procedure in 57% cases followed by partial thyroidectomy. All patients underwent retrosternal thyroidectomy through a cervical incision except for one case. Postoperative histopathology showed frequent benign multinodular goiter (83.3%), followed by papillary thyroid cancer (10%) and thyroiditis (6.7%). The most common complication after thyroidectomy was tracheomalacia (13.4%), transient hypocalcemia (10%), and hypoparathyroidism (6.7%). There was no intraoperative or perioperative mortality. Conclusion: RSG is a rare entity often presented with pressure symptoms, mostly involving anterior mediastinum and had a challenging surgical procedure. A large multicenter study is needed to include more cases in order to have a consensus on the definition and classification system for such important clinical goiter presentation.

Publisher

Hamad bin Khalifa University Press (HBKU Press)

Subject

General Medicine

Reference37 articles.

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