Primary Intrathoracic Goiter Research Articles

A rare case of both primary and secondary intrathoracic goiters

Primary intrathoracic goiter is a very rare entity representing only 1% of all intrathoracic goiters. It arises from mediastinal ectopic thyroid, without tissue connection with cervical thyroid and its blood supply is entirely derived from intrathoracic vessels.

정상 갑상선 환자의 일차성 다발성 흉강내 갑상선종의 수술적 치료 1예

정상 갑상선 환자의 일차성 다발성 흉강내 갑상선종의 수술적 치료 1예

Primary intrathoracic goiter: a rare mediastinal tumor

Background: Substernal goiters are usually classified as secondary or primary intrathoracic goiters. Primary ones result from an abnormal embryologic migration of the thyroid and represents less than 1% of all goiters. Secondary substernal goiters develop from the descent of the thyroid into the mediastinum and represents 98-99% of goiters.Methods: This was a retrospective study which discuss the symptoms, the diagnosis and the treatment of 7 primary intrathoracic goiters.Results: Goiter was located in the anterior mediastinum in 5 cases, in the posterior mediastinum in 1 case and in the medium mediastinum in 1 case. The mass was located on the right in 5 cases cervical approach was performed in 3 cases. Two patients required a transthoracic approach, 1 required sternotomy and in 1 case video-thoracic surgery was sufficient. Only one patient had postoperative complication which was secondary pneumothorax. All tumors were benign.Conclusions: Mediastinal ectopic goitre is rare. However it should be discussed among the different etiologies of mediastinal masses.

Primary retrosternal goiter mimicking as teratoma of anterior mediastinum: A diagnostic enigma

Primary intrathoracic goiters arising from aberrant thyroid tissue are rare, representing <1% of all retrosternal goiters (RGs). We report a rare case of primary RG in a male patient with symptoms of mediastinal mass lesion alone. By careful examination and with the help of radiological imaging, we could pick up a thyroid swelling with a mediastinal mass which led to a diagnostic dilemma, as the thyroid swelling was reported as a multinodular goiter and the mediastinal mass was misdiagnosed as teratoma. We subjected the patient to a functional imaging with a thyroid scintigraphy, which revealed a thyroid swelling with retrosternal extension that was managed by surgery (total thyroidectomy and mediastinal mass excision) with only a Kocher's neck crease incision.

Surgical treatment of substernal goiter: An analysis of 44 cases.

Substernal goiters are classified as primary or secondary intrathoracic goiters. Here, we report the diagnosis, symptoms, treatment, and postoperative complications of 44 substernal goiters (2 primary mediastinal goiter and 42 secondary mediastinal goiters). A retrospective chart review of 351 patients undergoing thyroidectomy at the Department of Otolaryngology-Head and Neck Surgery of the Tokyo Metropolitan Tama Medical Center. Between 2009 and 2015, 44 patients underwent surgery for substernal goiter. The frequency of primary and secondary mediastinal goiters was 0.5% and 11.9%, respectively. The preoperative symptoms were neck mass, dyspnea, and dysphagia. Eight patients were asymptomatic. Thirty-nine patients had benign masses and 5 patients had malignant masses. Most patients were operated on for adenomatous goiters (52.2%). In ten cases beyond the aortic arch, the tumors were benign and there were eight cases of adenomatous goiter. All patients underwent a successful transcervical incision without sternotomy. Even the primary intrathoracic goiters were extracted after total thyroidectomy via the cervical approach without complications. Although one case showed unilateral recurrent nerve paralysis as a postoperative complication, phonetic function improved in 6 postoperative months. No instances of postoperative bleeding or definitive hypoparathyroidism occurred, and tracheostomy was not performed in any of the cases. The cervical approach was safely performed in almost all substernal goiters without an extracervical procedure. Selected cases of primary mediastinal goiter may be excised via the cervical approach.

Combined Thyroidectomy and Cardiac Surgery

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.

Surgical management of primary intrathoracic goiters

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.

Intrathymic Primary Intrathoracic Goiter in a Patient With Breast Malignancy

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.

Primary intrathoracic goiter: Incidental diagnosis on 99m-Tc pertechnetate radioisotope thyroid scan

Primary intrathoracic goiter: Incidental diagnosis on 99m-Tc pertechnetate radioisotope thyroid scan

Incidental diagnosis of primary intrathoracic goiter on radionuclide 99m-tc pertechnetate radioisotope thyroid scan

Retrosternal goiters are classified into two groups. One is the truly primary intrathoracic or aberrant goiter. Presence of accessory thyroid tissue in the mediastinum of these patients group is congenital, with the blood supply derived entirely from intrathoracic vessels and it has no direct connection to the cervical thyroid gland. This primary intrathoracic goiter group represents less than 1% of surgically removed goiters. The much more common second group represents the acquired retrosternal goiter. It arises in the cervical thyroid gland and while growing it descends along a fascial plane, through the thoracic inlet into the mediastinum. Intrathoracic goiters usually present with clinical symptoms due to pressure on adjacent structures as the goiter enlarges within the rigid thoracic inlet. Asymptomatic large retrosternal, especially primary intrathoracic goiters are very uncommon. Here, we report a case of large retrosternal primary intrathoracic goiter found serendipitously on Technetium-99m (99mTc) pertechnetate radioisotope thyroid scan, which was missed on ultrasonogralhy (USG) neck in an asymptomatic patient presented with neck heaviness. Thus, here we emphasize the role of radioisotope thyroid scan over USG neck to diagnose retrosternal goiter.

Approach to management of the patient with primary or secondary intrathoracic goiter

胸内甲状腺肿占甲状腺手术治疗的45%,其中1%为原发性胸内甲状腺肿,其起源于纵隔的异位甲状腺组织,与颈部甲状腺无关联,血供来源于纵隔血管.胸内甲状腺肿大多数是继发性,由颈部甲状腺肿的重力作用坠入纵隔。

Approach to Management of the Patient with Primary or Secondary Intrathoracic Goiter

Intrathoracic (substernal) goiter, depending on definition, is seen in up to 45% of all patients operated for goiter. It can either be primary (ectopic thyroid tissue detached from a cervical thyroid mass), which is very rare (1%), or (more commonly) secondary, where a portion of the goiter extends retrosternally. There is no consensus on diagnostic or therapeutic management, partly because many are asymptomatic. Classification involves functional characterization with serum TSH and morphological characterization with diagnostic imaging and cytology to rule out malignancy, which is not more common than in cervical goiters. Pulmonary function is often affected in asymptomatic individuals also. Therefore, but also because natural history is continuous growth and evolution from euthyroidism to hyperthyroidism, most experts recommend therapy. In primary as well as secondary intrathoracic goiter, the therapy of choice is total/near-total thyroidectomy and subsequent levothyroxine substitution. Data suggest that complications are only slightly more prevalent than in cervical goiters. Although levothyroxine is not recommended for goiter shrinkage, there is increasing focus on radioactive iodine as an alternative to surgery in secondary intrathoracic goiters. Here it can reduce thyroid size by on average 40% after 1 yr and improve respiratory function and quality of life. Recent studies show that recombinant human TSH, currently used off-label, can augment the radioiodine-related goiter shrinkage by 30-50%. With currently used doses of recombinant human TSH, the side effects, besides hypothyroidism, are rare and mild. Future studies should also explore the use of radioiodine in primary intrathoracic goiter and compare surgery and radioiodine, head to head.

Substernal goiters: Incidence, surgical approach, and complications in a tertiary care referral center

Surgery is the treatment of choice for substernal goiters, but there are still some controversies on their definition, the surgical approach, and the complications rate. We analyzed our experience in a tertiary care referral center. Among a series of 2263 patients who underwent thyroidectomy between 2004 and 2008, 355 patients with substernal goiter were identified. A control group of 355 patients with cervical goiters operated on during the same period was selected. The operative and pathological characteristics and the complications rate of the 2 groups were compared. Only 2 patients (0.6%) required an extracervical approach (1 primary intrathoracic goiter and 1 recurrent carcinoma). No significant difference was found in terms of complications between the 2 groups. The cervical approach can be safely performed in almost all the patients with substernal goiters. An extracervical procedure has very limited indications. Substernal goiter is not associated with increased complications rate.

Primary Intrathoracic Goiter: A Rare and Potentially Serious Entity

Here we review primary intrathoracic goiter (P-ITG), a rare but potentially serious congenital entity that is distinct from the much more common secondary intrathoracic goiter. The latter is an extension of cervical thyroid that descends within the mediastinum. In contrast, P-ITGs lack a connection with the cervical thyroid and their blood supply comes from intrathoracic vessels. P-ITGs can coexist with a normal or goitrous thyroid gland. When they coexist, either or both may be independently affected by neoplastic, infectious, or infiltrative processes. P-ITGs are mainly located in the anterosuperior mediastinum. Location in posterior or middle mediastinum is observed in 15% of cases, making the diagnosis challenging. Although P-ITGs are rare, they are important because they may reach large dimensions with serious consequences. Compression of the trachea is the most common clinical finding, but compression of other mediastinal organs is also observed. Computerized axial tomography (CT) and radionuclide imaging can suggest or make the diagnosis in most cases. The differential diagnosis includes other mediastinal tumors that show high attenuation on unenhanced CT. The treatment of choice is surgical resection of the goiter through a thoracic approach. Thoracic surgery for resection of a small primary mediastinal goiter is considered to be a relatively safe procedure. Long-standing P-ITGs may cause pressure on the trachea, however, resulting in tracheomalacia. This development is serious in its own right and complicates thoracic surgery. Resection through a thoracic approach is the appropriate treatment for a P-ITG. Surgical intervention is usually indicated without delay upon the establishment of the diagnosis because these goiters exhibit progressive growth. When P-ITGs are small, this approach should prevent the development of tracheomalacia and other serious complications.

Primary Intrathoracic Goiter

Primary Intrathoracic Goiter

Primary Intrathoracic Goiter

ABSTRACT The differential diagnosis of a middle mediastinal mass is fairly broad. Though relatively rare, the diagnosis of primary intrathoracic goiter is a clinically important consideration that should not be overlooked. The nature of this clinical entity and its diagnostic implications are discussed. Relevant radiographic imaging is evaluated demonstrating the key findings. Indications for intervening and treatment options are reviewed. Specifically, the presence of a growing substernal goiter in an otherwise fit patient is generally an indication for surgical resection. The nature of a primary intrathoracic goiter usually obviates the more common transcervical approach since by definition the mediastinal goiter is discontinuous with the cervical thyroid gland. Other transthoracic approaches are therefore necessary.

Primary Intrathoracic Goiter

Nodular goiter is a common disease in Taiwan, and substernal or intrathoracic goiters are not infrequent. However, intrathoracic goiters are mainly of the secondary type and primary intrathoracic goiters are rarely seen. We report a 55-year-old woman who was incidentally found to have an ectopic goiter located in the anterior upper mediastinum with the initial presenting symptom of productive cough. Imaging studies including chest X-ray and computed tomography identified the lesion, and 131I-uptake scan showed weak uptake in the thorax. Surgical removal via thoracotomy was performed and the diagnosis was confirmed by pathology. A primary intrathoracic goiter, although rare, should also be considered in the differential diagnosis of mediastinal tumor.

Primary Intrathoracic Goiter on Scintigraphy

A 69-year-old woman with a history of goiter and thyrotoxicosis over the previous year was seen for radioiodine therapy. At the time of a previous ablation with I-131, a thyroid scan was performed after administration of Tc-99m sodium pertechnetate. Scintigraphy showed an enlarged thyroid gland with increased thyroid uptake in the neck at its normal location along with mediastinal uptake. Contrast enhanced computed tomography (CT) showed an anterior mediastinal mass. This mass was excised. Histologic study demonstrated an ectopic primary intrathoracic nodular goiter at the site of increased activity seen on Tc-99m pertechnetate imaging.

The Clinical Presentation and Operative Management of Nodular and Diffuse Substernal Thyroid Disease

Patients with substernal thyroid disease, defined by the presence of enlarged thyroid tissue below the plane of the thoracic inlet, were identified from a prospective database maintained for patients who have undergone thyroidectomy at our institution since 1990. Substernal thyroid disease was present in 116 (30%) of 381 patients, anterior mediastinal in 109 (94%), and posterior mediastinal in seven (6%). Indications for surgery included compressive symptoms in 75 (65%) patients, an abnormal fine-needle biopsy in 45 (39%), progressive thyroid enlargement in 41 (35%), thyrotoxicosis in 11 (10%), and superior vena cava syndrome in two (1.7%). A median sternotomy and thoracotomy were performed in one patient each for a primary intrathoracic goiter. In all other patients thyroidectomy was accomplished through a cervical incision. Parathyroid autotransplantation was performed in 41 (37%) patients with retrosternal disease compared with 57 (22%) with disease confined to the neck (P < 0.01). Twenty-five patients (22%) had malignancy; four of these had unresectable disease. Postoperative complications included transient hypocalcemia (n = 46), transient hoarseness (n = 7), recurrent laryngeal nerve injury (n = 1), and wound infection (n = 1). One patient died from aspiration pneumonia. In summary, substernal thyroid disease is typically present in the anterior mediastinum and with rare exceptions can be resected through a cervical incision. Parathyroid devascularization is more common with resection of a substernal goiter and autotransplantation can prevent permanent hypoparathyroidism.

Acute Suppurative Thyroiditis in a Primary Intrathoracic Goiter

To describe a case of acute suppurative thyroiditis and focal abscess formation in a patient with a primary intrathoracic goiter. We summarize the initial clinical manifestations, the pathologic findings, and the surgical treatment of a woman with an enlarging mediastinal mass. A 41-year-old woman had a fever and a sudden increase in severity of compressive symptoms after a remote urinary tract infection. Smears from an intraoperative fine-needle aspiration biopsy showed necrotic debris, polymorphonuclear leukocytes, hemosiderin-laden macrophages, and degenerated follicular epithelial cells. Urine and tissue cultures grew Escherichia coli. The patient underwent resection of an 800-g primary intrathoracic goiter with associated degeneration, necrosis, hemorrhage, and abscess formation. To our knowledge, this is the first reported case of acute suppurative thyroiditis and abscess formation occurring within a primary intrathoracic goiter.