Clinical manifestations and surgical approach of retrosternal goiter: A case report
Main Article Content
Keywords
Retrosternal goiter, Thyroid, Sternotomy
Abstract
Introduction: Retrosternal goiter is an enlarged thyroid gland that extends into the mediastinum and is often asymptomatic until discovered incidentally on radiological examination. This report aims to describe the clinical manifestations, radiological findings, and surgical considerations in a case of a large retrosternal goiter successfully resected using a combined transcervical approach and a full sternotomy.
Case description: A 66-year-old woman presented with chief complaints of shortness of breath and cough. Physical examination revealed a diffusely enlarged thyroid gland with a nonpalpable lower border and decreased vesicular breath sounds in the right hemithorax. Laboratory results showed a thyroid-stimulating hormone (TSH) level of <0.05 µIU/mL and a free thyroxine (FT4) level of 7.61 pmol/L. A chest radiograph revealed a mass in the right upper lung field, while a chest computed tomography (CT) showed a retrosternal mass associated with the thyroid gland and extending into the mediastinum. The patient underwent a total thyroidectomy using a combined transcervical approach and full sternotomy. The removed tissue measured 9 × 6 × 4 cm, and histopathological examination confirmed the diagnosis of papillary thyroid carcinoma with follicular differentiation.
Conclusion: Most retrosternal goiters can be resected via a transcervical approach, but a full sternotomy is necessary in cases with bilateral thoracic extension, exceeding the thoracic inlet, or associated tracheal narrowing. This approach provides extensive visualization of the mediastinum, facilitates bleeding control, and reduces the risk of surgical complications.
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