Evaluations of Factors Predicting the Need for an Extra-Cervical Approach for Intra-Thoracic Goiter

Introduction: Intra-thoracic goiter refers to the extension of enlarged thyroid tissue into the thoracic inlet. This condition can produce symptoms of compression on adjacent organs and can sometimes be accompanied by malignant transformation. Therefore surgical treatment is almost always necessary. In order to remove the pathology with the fewest post-operative complications, selection of the appropriate surgical approach is essential. In this study we aimed to detect the criteria which help us select the best therapeutic approach.   Materials and Methods: In this retrospective study, 82 patients with intra-thoracic goiter were investigated. Their data were extracted from medical records and analyzed using SPSS software.   Results: Overall 82 patients, 18 (21%) males and 64 (78%) females with mean age of 56.38 years were studied. The most common clinical symptoms were mass (95%) and dyspnea (73%). In most patients, the surgical approach was cervical (90.2%), while 9.8% of patients required an extra-cervical approach. Post-operation complications were observed in 17.1% of patients; the most common being transient recurrent laryngeal nerve paralysis (4.9%). Malignancy was reported in the histopathology of seven patients (8.5%). The most common malignant histopathology was papillary thyroid carcinoma (7.3%). Extension of the thyroid tissue below the uppermost level of the aortic arch was significantly correlated with the need for an extra-cervical approach to surgery (P<0.001).   Conclusion:  Because of the compressive effect and risk of malignancy, intra-thoracic goiters require immediate surgical intervention. Commonly, cervical incision is used for removing the extended goiter to the mediastinum. Extension of the goiter below the uppermost level of the aortic arch increases the likelihood of an extra-cervical approach being required.

Keywords:

Cervical incision , Intra-thoracic goiter , Mediastinal goiter , Sub-sternal goiter , Sternotomy , Thyroid , Thyroidectomy