Retrosternal Goiter Research Articles

Residual Retrosternal Goiter and Thymolipoma After Cervical Thyroid Resection

Residual Retrosternal Goiter and Thymolipoma After Cervical Thyroid Resection

7046 Thyroid Storm After Thyroidectomy Without Underlying Hyperthyroidism

Abstract Disclosure: A.J. White-Cotsmire: None. B. Kodali: None. C. McHenry: None. M. Rahhal: None. Background: Thyroid storm is a feared complication of total thyroidectomy; however, this is a rare phenomenon seen primarily in patients with undiagnosed or poorly controlled thyrotoxicosis from Graves’ disease. Preoperative treatment of patients with hyperthyroidism with beta-adrenergic blockers and anti-thyroid medication to ensure that patients are euthyroid prior to thyroidectomy have largely eliminated this risk of thyroid storm. (1) We report a case of thyroid storm caused by release of preformed thyroid hormone, following extensive manipulation and resection of a large retrosternal nontoxic multinodular goiter. To our knowledge, this has not yet been previously described. Clinical Case: A 57yo female underwent a total thyroidectomy with resection of a large benign multinodular goiter with retrosternal extension, which was causing compressive symptoms. She had a nodular goiter for 7 years that was increasing in size. Fine needle aspiration 2 years prior to surgery demonstrated colloid and adenomatoid nodules with Hurthle cell changes. She had no history of hypo- or hyperthyroidism. TSH prior to surgery was 0.576µIU/ml (normal = 0.450-5.330µIU/ml). Extensive manipulation was required to deliver the goiter from beneath the manubrium. Pathology from her thyroid revealed a multinodular goiter without evidence of malignancy. Post-operative course was uncomplicated, and after an overnight stay, the patient was discharged home with 150mcg (1.5mcg/kg) levothyroxine daily. She presented to the emergency department 4 days later and was admitted to the intensive care unit with diffuse abdominal pain, nausea, vomiting, and myalgias, and she was diagnosed with atrial fibrillation with rapid ventricular response. TSH on admission was 0.020 µIU/ml, thyroglobulin levels were >2,250.0ng/mL (n=0.8 – 48.0 ng/mL), thyroglobulin antibodies were negative. Her levothyroxine was stopped, her heart rate was controlled with metoprolol, and she was started on oral anticoagulation with rivaroxaban. She was discharged after a 7-day hospital stay. At 3 weeks follow-up her TSH was 35.67µIU/ml and her thyroglobulin levels were 23.9ng/mL. Her symptoms had resolved, and levothyroxine was resumed at a lower dose of 137mcg daily. Six weeks later her TSH level was 7.785µIU/ml, and her thyroglobulin was 1.8ng/mL. Conclusion: To our knowledge, this is the first case of thyroid storm reported following thyroidectomy in a patient with nontoxic multinodular goiter in a clinically and biochemically euthyroid patient. Massive increase in thyroglobulin postoperatively and rapid resolution of symptoms suggest that the release of preformed thyroid hormone related to vigorous thyroid manipulation was likely the cause. Reference: (1) Christou N, Mathonnet M. Complications after total thyroidectomy. Journal of Visceral Surgery. 2013;150(4):249-256. doi:10.1016/j.jviscsurg.2013.04.003 Presentation: 6/1/2024

Minimal Invasive Resection of Large Retrosternal Thyroid Goiter.

Resecting a large goiter extending into the retrosternal space is challenging, especially when a sternotomy or thoracotomy is required. The transthoracic approach is linked to higher postoperative morbidity, reaching up to 30% when compared to the transcervical approach. Although alternative options like thoracoscopic resection have shown promising results, the morbidity of mediastinal dissection remains a concern. Thoracoscopic-assisted transcervical approach might be a feasible, less invasive alternative. This video outlines the steps and potential pitfalls of the procedure. The patient is positioned supine with an extended neck. Initially, the endocrine surgeon mobilizes the thyroid gland through cervical access. If a transcervical resection is not feasible, the patient is mobilized into a lateral decubitus position, and a second team thoracoscopically guides the mediastinal tumor through the thoracic inlet. This allows a stepwise controlled transcervical dissection of the retrosternal mass until complete resection is achieved, thus eliminating the need for mediastinal dissection. To demonstrate the procedure, we present the case of an 84-year-old male with lymph node-positive oncocytic thyroid carcinoma and a large retrosternal goiter extending posteriorly into the mediastinum up to the aortic arch. Thoracoscopic-assisted transcervical resection was performed. The recurrent laryngeal nerve was identified and monitored with a neurostimulation device during dissection. No palsy was noted in the postoperative evaluation. The patient had an uneventful postoperative course and was discharged on the second postoperative day. Thoracoscopic-assisted transcervical resection of large retrosternal goiter seems a feasible alternative to mitigate risks associated with thoracotomy, sternotomy, or thoracoscopic mediastinal dissection. Potential advantages include decreased postoperative morbidity and length of stay. This technique requires thoracoscopic expertise and may be limited depending on the goiter's size and mediastinal positioning.

Perioperative results between cervical and retrosternal goiter : An international multicenter analysis

Perioperative results between cervical and retrosternal goiter : An international multicenter analysis

ThP2.8 - Reducing postoperative length of stay after thyroidectomy through a standardised multidisciplinary postoperative care protocol does not compromise patient safety

Abstract Aims Our unit had a significantly longer length of stay after thyroid surgery. We introduced change of practice through a standardised multidisciplinary postoperative care protocol. We analyse the effect of the protocol on postoperative length of stay and any impacts on patient safety. Methods A multidisciplinary protocol was implemented and embedded into clinical practice. Data was collected prospectively on consecutive patients undergoing thyroid surgery. Outcomes with reference to adverse events, length of stay and readmissions were audited. Comparisons were made with unit's pre-protocol data and national figures published in BAETS (British Association of Endocrine and thyroid Surgeons) audit report. Results A total of 78 patients underwent 37 total thyroidectomies and 41 lobectomies. Three (8.3%) of the total thyroidectomies had transient hypocalcaemia but none were permanent. None had voice changes or recurrent laryngeal nerve palsy. Three patients were reviewed few days after discharge with mild hypocalcaemia symptoms treated with calcium supplements. One was re-admitted 5 days post discharge with wound infection. Twenty-seven (75%) were discharged on 1st postoperative day as opposed to 0% pre-protocol (BAETS audit report 66%). Thirty-seven (90%) of lobectomies were discharged on 1st postoperative day (Units pre-protocol 42%, BAETS audit 81%). There was no postoperative bleed or hypocalcaemia. One patient with a large recurrent retrosternal goitre had transient recurrent laryngeal nerve palsy that recovered subsequently. There were no readmissions or adverse events directly related to early discharge. Conclusion A well embedded dedicated postoperative care protocol can significantly reduce postoperative hospital stay after thyroid surgery without compromising patient safety.

Challenges for a perioperative physician – A choking thyroid planned for total thyroidectomy

A large retrosternal goiter is a nightmare for an anesthesiology and a surgeon. A comprehensive history, a thorough clinical examination, pre-operative planning and a close working relationship among multidisciplinary medical teams are prerequisites to prevent adverse events intra-operatively and postoperatively. This case report is about a geriatric patient who presented with progressively enlarged anterior neck swelling for past 30 years associated with orthopnea and dysphagia. Patient underwent awake fibreroptic intubation under topical anesthesia. Thyroidectomy combined with sternotomy was done. Intra-operative and postoperative was uneventful.This case report suggests the use of AFOI in anticipated difficult airway and it’s success.

Factors predicting the use of the backward upward rightward pressure maneuver in thyroid surgery: a single-center retrospective cohort study

BackgroundThe purpose of this study was to evaluate the predictability of utilizing the backward upward rightward pressure (BURP) maneuver and the efficacy of related tests in patients with a challenging airway and a Mallampati score of 2 or higher who underwent scheduled elective thyroid surgery.MethodsPatient files were scanned for 300 adult patients who had undergone thyroid surgery under general anesthesia. The information included their medical history of thyroid disease, previous thyroid surgery, and evaluation tests for difficult intubation such as Mallampati score, maximum mouth opening, ease of intubation, thyroid goitre grade, and whether the BURP maneuver was performed. Patients who had a history of difficult intubation or a Cormack Lehane score less than 2 were excluded. Additionally, the patients were divided into two groups: one group underwent the BURP maneuver (n = 78) and the other did not (n = 56).ResultsStatistically significant differences in the maximum mouth openings and thyroid goitre grade were observed between the groups according to the preoperative evaluation. Furthermore, significant differences were noted between the groups in terms of the ease of intubation, intubation time, Cormack–Lehane score, and number of intubation attempts.ConclusionThere may be a correlation between the maximum mouth opening and thyroid goitre grade in predicting the use of the BURP maneuver. It is important to keep in mind, however, that difficult intubation may occur in some uncommon types of goiter, such as retrosternal goiter, even if the thyroid gland size is small. Therefore, it may be useful to consider performing the BURP maneuver.

Stridor due to massive retrosternal goitre

An independent 90 year old woman presented to the emergency department in respiratory distress. Background medical history included a known retrosternal goitre under observation, previous right sided thyroid lobectomy and recent lower respiratory tract infection treated with oral antibiotics.

A rare clinical case of malignant ectopic retrosternal goiter of a large size in a patient with aberrant right subclavian artery

Background. Ectopic goiter accounts for only 0.2 % to 1 % of all mediastinal goiters. The aberrant right subclavian artery (arteria lusoria) is an extremely rare anomaly of the major vessel, with a prevalence not exceeding 0.3 % in the general population. This paper presents the first case of malignant ectopic retrosternal goiter of a large size in combination with the aberrant right subclavian artery. Clinical case description. A 61-year-old male presented to the thoracic surgery department of P. Herzen Moscow oncology Research institute with a large posterior mediastinal mass measuring 108×106×79 mm and adjacent to the right lobe of the thyroid gland. The tumor displaced the trachea and esophagus. Open biopsy through a thoracotomy incision revealed thyroid gland cells without signs of atypia. A detailed examination revealed mediastinal vascular anomaly – retrotracheal position of the right subclavian artery. a complete longitudinal sternotomy, complemented by a right-sided thoracotomy at the 3rd intercostal space, served as the surgical approach. The operation lasted 320 minutes, with a blood loss of 3500 ml. The postoperative period was uneventful. The morphological examination of the surgical specimen revealed nodular hyperplasia of the ectopic thyroid tissue with the growth of well-differentiated follicular carcinoma without metastatic involvement of removed lymph nodes. Considering the identified follicular carcinoma, total thyroidectomy was performed. Conclusion. In surgical planning, it is crucial to assess the location of major mediastinal vessels and their relationship with the goiter. Therefore, all patients with mediastinal lesions should undergo preoperative contrast-enhanced ct. Retrosternal goiter predisposes to a higher rate of malignancy compared to cervical goiter. If the lower edge of the goiter is at the level of or below the aortic arch, cervical access should be supplemented with sternotomy. In cases of a massive thoracic component, additional thoracotomy is justified.

The evaluation of simultaneous combined surgery of the heart and thyroid - own experience

Background: Patients referred for cardiac surgery usually also have other comorbidities. These include thyroid disease, which is relatively common in patients with heart problems. Objective: The aim of the study was to evaluate the feasibility of combined cardiac surgery and thyroidectomy. Material and methods: Six patients (age range: 54-74 years) qualified for elective, simultaneous surgeries on the heart and the thyroid were included in the study. In preparation for thyroidectomy, three patients were diagnosed with diseases requiring cardiac surgery. Two patients, initially referred for coronary artery bypass surgery in one case, and surgery for recurrent fluid in the pericardial sac with concomitant mitral and tricuspid valve regurgitation and atrial fibrillation in the other, were diagnosed in large hyperactive goitre. The last patient with a history of oncology (lung tumour), admitted to the Department of Cardiology due to a heart attack, had a CT scan of the chest, which revealed retrosternal goitre narrowing the lumen of the trachea to 9 mm. All patients underwent combined heart and thyroid operation and were discharged home 8-27 days after surgery. Conclusions: Although preoperative qualification requires a very cautious and individual approach, simultaneous surgeries in patients requiring thyroid and heart interventions are expedient and should be promoted.

Surgical Management and Predictors of Postoperative Complications of Retrosternal Goiters: A Retrospective Study.

The preferred standard treatment for retrosternal goiter (RSG), a slow-growing, often benign tumor, remains thyroidectomy. An alternative strategy may be required when the goiter is intrathoracic. Data on the results of RSG procedures are rarely reported. Careful patient selection and assessment are critical to avoiding an unexpected sternotomy during surgery and postoperative complications. This study aims to examine the clinical findings and treatment outcomes of RSG and to identify the variables affecting postoperative complications in a resource-limited setting. A retrospective study was conducted at Al-Thawra Modern General Hospital in Sana'a, Yemen, on 69 patients diagnosed with RSG and undergoing thyroidectomy between April 2019 and February 2023. Initial clinical characteristics, radiological and laboratory findings, treatment approach, and outcome were collected from the patient's medical profile and analyzed. To determine the variables influencing postoperative complications, a bivariate analysis was carried out. The mean age was 51.0 ± 13.6 years, and 45 (65.2%) were female. The most commonly reported symptoms were palpable masses (66; 95.7%), difficulty breathing (45; 65.2%), and neck discomfort (20; 29.0%), with 7 (10.1%) patients being asymptomatic. Previous thyroid surgery was reported in 10 (14.5%) cases. According to the grading classification, grade 1 was the most prevalent (42; 60.9%). Total thyroidectomy was the predominant surgical procedure in 59 (85.5%) cases. Using a cervical approach, all patients underwent thyroidectomy, and a sternotomy was required in one case. Histopathological analysis revealed benign multinodular goiter in 79.7%, followed by papillary thyroid cancer in 10.1% and thyroiditis in 6.7%. The postoperative complication occurred in 22 (31.9%), and the most common complication was transient hypocalcemia (11, 15.9%). There was no mortality during or after the surgery. In bivariate analysis, advanced age, difficulty swallowing, tracheal deviation, large RSG mass, advanced RSG grade, previous surgery, and malignant histopathology were associated with postoperative complications and were statistically significant (all p<0.05). RSG is a rare disease that may require challenging surgical intervention. In this study, the cervical approach was the most practical and least intrusive surgical method. In addition, postoperative complications were associated with advanced age, difficulty swallowing, tracheal deviation, large RSG mass, advanced RSG grade, previous surgery, and malignant histopathology. Low postoperative complication rates can be achieved by understanding the surgical architecture of the neck, essential clinical RSG presentation, thyroid pathology, and necessary surgical treatment.

A Rare Case of Anatomical Variation of Inferior Thyroid Artery Originated From the Brachiocephalic Trunk During Retrosternal Goiter Excision.

Vascular variations are prevalent among the human population. However, the occurrence of anatomical variations in the inferior thyroid artery originating directly from the brachiocephalic trunk (BCT) is exceptionally rare, as confirmed by numerous research studies. In addition, reliable departmental statistics reveal that the incidence rate of retrosternal goiter is approximately 19%. In this case study, the variation blood vessels in the neck were accidentally found and analyzed. Simultaneously, we conducted an analysis on the clinical significance of a rare anatomical variation. The study focused on a 60-year-old female patient who underwent a surgery for retrosternal goiter, during which it was discovered that the inferior thyroid artery originated from the BCT. Our report presented a unique case involving this particular combination of anatomical variations within the BCT. The anatomical variation reported in our study will effectively reduce the risk of patients and enhance our comprehension of this anatomy's characteristics, thereby avoiding the occurrence of iatrogenic complications.

Characteristics of anesthetic and surgical tactics in treatment of a patient with a giant thyroid mass in a cancer center (clinical case)

This paper describes an example of radical surgical treatment of a patient with a giant retrosternal goiter complicated by compression of the organs of the neck and mediastinum. Considering all the risks and possible complications, we should take into account the fact that enlarged thyroid (T) body with retrosternal location can cause displacement and stenosis of the trachea and esophagus, and dislocation of large vessels and nerves of the mediastinum. This anatomical specificity is an imminent threat to successful treatment, and it also carries a certain risk of asphyxia and sudden death of the patient. In this clinical case, radical surgical treatment in this patient included sequential mobilization in two pleural cavities, and then the total removal of T through the traditional surgical access. The anesthetic complexity to support the surgical intervention involved both difficult intubation due to tracheal stenosis, and also the required separate ventilation of the lungs to visualize anatomical structures and mobilize a multinodular formation in two pleural cavities. Standard methods of artificial lung ventilation could be ineffective and even dangerous in this case due to the location and size of the tumor. We focused our attention on high-frequency ventilation (HFV), the best method of respiratory support during surgeries for tracheal and bronchial pathologies. The main task of the anesthetic team in this clinical case was to prevent the development of hypercapnia and hypoxia during intubation of the stenotic tracheal segment, and then adequate ventilation of the lungs with reduced area of proper gas exchange due to bilateral surgical pneumothorax. Thus, the full treatment was carried out due to the only safe method of compensating lung ventilation with anesthesia by HFV. The applied HFV method creates an adequate gas exchange in the lungs due to the small ventilation volume and high frequency of respiratory cycles per minute. HFV both prevented the development of threatening complications during intubation of the stenotic tracheal area and ensured an adequate gas exchange during successive thoracoscopic stages of thyroid tumor mobilization.

Differences in surgical outcomes between cervical goiter and retrosternal goiter: an international, multicentric evaluation.

Goiter is a common problem in clinical practice, representing a large part of clinical evaluations for thyroid disease. It tends to grow slowly and progressively over several years, eventually occupying the thoracic inlet with its lower portion, defining the situation known as retrosternal goiter. Total thyroidectomy is a standardized procedure that represents the treatment of choice for all retrosternal goiters, but when is performed for such disease, a higher risk of postoperative morbidity is variously reported in the literature. The aims of our study were to compare the perioperative and postoperative outcomes in patients with cervical goiters and retrosternal goiters undergoing total thyroidectomy. In our retrospective, multicentric evaluation we included 4,467 patients, divided into two groups based on the presence of retrosternal goiter (group A) or the presence of a classical cervical goiter (group B). We found statistically significant differences in terms of transient hypoparathyroidism (19.9% in group A vs. 9.4% in group B, p < 0.001) and permanent hypoparathyroidism (3.3% in group A vs. 1.6% in group B, p = 0.035). We found no differences in terms of transient RNLI between group A and group B, while the occurrence of permanent RLNI was higher in group A compared to group B (1.4% in group A vs. 0.4% in group B, p = 0.037). Moreover, no differences in terms of unilateral RLNI were found, while bilateral RLNI rate was higher in group A compared to group B (1.1% in group A vs. 0.1% in group B, p = 0.015). Wound infection rate was higher in group A compared to group B (1.4% in group A vs. 0.2% in group B, p = 0.006). Based on our data, thyroid surgery for retrosternal goiter represents a challenging procedure even for highly experienced surgeons, with an increased rate of some classical thyroid surgery complications. Referral of these patients to a high-volume center is mandatory. Also, intraoperative nerve monitoring (IONM) usage in these patients is advisable.

Extended cervical approach for retrosternal multinodular goiter.

Partial or total sternotomy is required for 10% of retrosternal goiter. This study reviewed our experience with an extended cervicotomic approach as an alternative surgical solution for retrosternal goiter. A retrospective study was performed on patients who underwent partial or total thyroidectomy for retrosternal goiter between 2014 and 2019 at a tertiary medical centre. Data on clinical, radiologic, and pathologic factors were analysed. Peri- and postoperative outcomes were compared between extended and standard cervical approaches to predict the need for an extended cervical approach. The cohort included 265 patients, of whom 245 (92.4%) were treated by standard thyroidectomy. In 17 (6.4%), the standard approach proved insufficient, and the horizontal incision was extended to a T-shape to improve access. The remaining 3 patients required a sternotomy. Use of the extended cervical approach was significantly associated with clinical features such as male gender, diabetes, high body mass index and postoperative hypocalcaemia. The extended cervicotomic approach is an alternative surgical solution for retrosternal goiter, with no increased risk of significant post-operative complications.

A rare case report of accessory thyroid in the superior mediastinum in the form of multinodular goiter

Retrosternal expansion of a goiter is one of the most common types of mass in the upper mediastinum. Although there is no clear definition of retrosternal, substernal, or mediastinal goiter in the literature, it usually refers to an extension of thyroid tissue from the cervical part that continues to the anterior mediastinum of the aortic arch. One of the interesting features of these cervical mediastinal lesions is that they may not be continuous. Such goiter types classically present with compression symptoms such as dyspnea, dysphonia, dysphagia, or sleep apnea, and less frequently, these masses can compress neurovascular structures, leading to superior vena cava (SVC) syndrome and Horner’s syndrome. In our case report, A 47-year-old female from North Karnataka presented to the hospital with history of dyspnea, dysphonia, and dysphagia persisting for the last 3 years. After careful examination and investigation, a diagnosis of thymoma was made initially. However, upon biopsy of the excised tumor, unexpected finding was revealed, it was identified as a multinodular goiter (MNG) rather than a thymoma.

Kompresivna priroda retrosternalne strume

Mediastinal masses originate from the structures of the mediastinum or neck organs and can represent primary benign or malignant tumors, as well as metastases. In most cases, they are detected through radiological imaging, such as an X-ray of the enlarged mediastinum. In the differential diagnostic approach, the acronym "the terrible T" (thymoma, teratoma, terrible lymphoma, and thyroid) is useful. A retrosternal goiter with its compressive effect can lead to changes in the voice, difficult speaking, tracheal compression, and potentially superior vena cava syndrome. Additionally, visualization techniques, thyroid hormones, and tumor markers can be helpful in the diagnostic process. We presented a patient who, during a meal, stopped eating, lost consciousness, and experienced asystole. Due to a chest injury sustained during resuscitation, a computerized tomography (CT) scan was performed. The CT scan revealed a nodular formation in the right lobe of the thyroid gland that extends through the upper thoracic aperture behind the sternum, exerting a pronounced compressive effect on the trachea. Based on the examination, it was concluded that the patient has a goiter with retrosternal and mediastinal extension, accompanied by thyrotoxicosis, which was most likely induced by the iodine contrast agent. Thyrostatic therapy was initiated, followed by surgical treatment of the retrosternal goiter. Computed tomography is the most accessible form of imaging for preoperative assessment of goiter position and its extent, while surgery remains the gold standard for treating symptomatic retrosternal goiters.

A Case Series Reflecting Airway Difficulty Challenges: Insights into Intubation and Extubation for Large Retrosternal Goitres

Retrosternal goitres, often due to longstanding thyroid enlargement, can compress critical structures like the trachea and oesophagus, necessitating thyroidectomy. Managing the airway while ensuring patient safety presents a significant challenge for anaesthesiologists. This case series explores the complex airway management in three patients with large retrosternal goitres undergoing total thyroidectomy. The patients, aged 50, 60, and 73, presented with long-standing neck swelling, tracheal deviation and symptoms including breathlessness, dysphagia and hoarseness of voice. The goitres had progressively enlarged over many years, leading to significant tracheal compression and deviation, which posed a high-risk for airway obstruction during surgery. Given these challenges, Awake Fiberoptic Intubation (AFOI) was chosen to secure the airway while minimising the risk of airway loss. AFOI was performed under conscious sedation with dexmedetomidine and local anaesthesia, providing effective intubation with minimal discomfort and stable haemodynamics. This approach was critical in managing the anticipated difficult airway due to the retrosternal extension of the goitres and their impact on surrounding structures. Postoperatively, the patients were kept intubated to prevent tracheomalacia, a potential complication arising from prolonged tracheal compression. Tracheomalacia, characterised by the weakening of tracheal walls, can lead to airway collapse after extubation. To ensure airway stability, extubation was delayed until a satisfactory cuff-leak test was performed 24-36 hours after surgery. This case series emphasises the importance of careful preoperative planning and the use of AFOI in managing patients with large retrosternal goitres to avoid a ‘can’t intubate, can’t ventilate’ situation. The successful management of these cases highlights the effectiveness of AFOI in reducing perioperative risks and ensuring patient safety, particularly in scenarios where difficult airway management is anticipated. By implementing appropriate postoperative protocols, the risk of complications such as tracheomalacia can be significantly reduced, leading to improved surgical outcomes.

Evaluation of thoracic inlet view plain radiograph in the management of patients with goitre.

Thoracic inlet view radiograph is an investigation for assessing patients with goitre in many centres in the sub-Saharan-region. However, there is paucity of information on its usefulness in the diagnosis of retrosternal goitre (RSG) and in planning for thyroidectomy. A review of patients with goitre managed in the Division of Endocrine Surgery, University College Hospital, Ibadan, Nigeria, between 2002 and 2014 was done. Data were obtained from Operating Theatre Log and electronic data archive of the Division. Clinical RSG (CRSG) was taken as a gland that the examining fingers could not get below its lower margin and Radiological RSG (RRSG) on thoracic inlet view was any extension of the thyroid gland beyond the thoracic inlet. Intra-operatively, if any part of the gland extends beyond the thoracic inlet it was considered as an RSG. 221 (96.5%) of the 229 patients who had thoracic inlet plain radiograph were included in this study. The Male to Female ratio was 1:5.5. WHO grade III goitre was seen in 56.1% of the patients and 43.9% had grade II goitre. The CRSG, RRSG and Intra-operative RSG were seen in 7.7%, 16.7% and 17.6% respectively. The specificity and sensitivity of clinical examination in determining RSG was 88.7% and 94.1% and that of Thoracic inlet radiograph was 97.8% and 94.6% respectively. It is a useful study for screening patients with goitre for retrosternal extension, however it could not be used to determine the need for extra-cervical surgical access during thyroidectomy.

Clinical application of retrograde thyroidectomy from top to bottom in retrosternal thyroid surgery

Objective:To investigate the value of retrograde thyroidectomy from top to bottom in the operation of retrosternal thyroid surgery. Methods:Retrospective analysis was performed on the cases of retrosternal goiter excised by our surgeons from January 2017 to June 2022,the technical points, feasibility and advantages of the operation were summarized. Results:A total of 15 cases of retrosternal goiter treated by retrograde thyroidectomy were collected, including 5 cases of type Ⅰ retrosternal goiter and 10 cases of type Ⅱ retrosternal goiter.The postoperative pathology was benign. The surgical time is 40-60 minutes for unilateral retrosternal goiter and 70-90 minutes for bilateral goiter. All patients were discharged normally within 7 days after operation, and no operative complications were observed such as bleeding, hoarseness or hypoparathyroidism. Conclusion:This surgical excision method of thyroid is suitable for the type Ⅰ and type Ⅱ retrosternal goiter surgery, which can avoid the difficulties in exposing and separating the the inferior thyroid behind the sternum in conventional surgical method, speed up the operation and reduced the difficulty of operation, and has certain promotion value in clinic.