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.
Highlights
The thyroid gland is anatomically located in the neck region
As regional data are scarce on such a rare disorder, we aim to present our experience of retrosternal goiter (RSG) to explore the demographic characteristics, clinical presentation, classifications, management, and outcomes of this thyroid entity in a tertiary care hospital
The records of these patients were analyzed with regard to the demographics, clinical presentation, comorbidities, personal and family history of cancer, radiological imaging and fine-needle aspiration cytology (FNAC; ultrasound-guided and clinic) findings, RSG classification, operation type, surgical approaches, excision type, and clinical followup
Summary
The thyroid gland is anatomically located in the neck region. When it gets localized or generalized hypertrophy, it is referred to as goiter. The natural history of goiter is suggestive of the slow development of symptoms and progressive enlargement with subsequent obvious neck swelling, pressure symptoms, or secondary hormonal dysfunctions.[1] The most frequently reported symptoms are dyspnea, choking, sleep discomfort, dysphagia, and hoarseness, which are mainly related to the airway and esophageal compression.[2] The thyroid gland upon enlargement may extend down into the mediastinum, and if more than 50% of the mass extended into the mediastinum, it is described as retrosternal (or substernal) goiter.[2] Because of the diversity in the definition of substernal goiters, the reported rates vary greatly between 5% and 22%.1. Conclusion: RSG is a rare entity often presented with pressure symptoms, mostly involving anterior
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