A Rare Case of Huge Retrosternal Goitre Managed by Total Thyroidectomy with Medial Sternotomy

Abstract

Retrosternal goitre is very rare condition which account for 5 to 20 % of thyroidectomy patients. Though rare, it can be better managed surgically. In this article we report a rare case of 60 year old female who had nodular goiter with huge retrosternal extension. Majority of retrosternal thyroid can be removed safely by conventional cervical approach. Our patient had around 20 x 18 x 6 cm mass which was impossible to remove it from conventional approach and hence total thyroidectomy with medial sternotomy was done. Procedure was uneventful and patient is doing fine in of follow-up. The role of thyroidectomy in patients with retrosternal goitre provides yet another area of surgical controversy I. Introduction Retrosternal goiter is defined when 50 % of the thyroid is below the thoracic inlet. This can also be called as intrathoracic goiter. Retrosternal goiter is a very rare condition which account for 5 to 20 % of thyroidectomy patients. Mediastinal extension is more common in huge goiters with a peak incidence in 5th to 6th decade. This is usually rare when the patient has associated hyperthyroidism which may increase the risk of complications. The reported incidence of goiters with thyroid malignancy is around 3 to 17 %. Retrosternal goitre occurs when the thyroid enlarges downwards into the chest. Although the great majority of retrosternal goitres are extensions from the neck, pure intrathoracic goitres are very rare. Any goitre that descends below the plane of thoracic inlet and growing into the anterior mediastinum for > 2cms.