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Substernal Goiter


Presentation

  • This report describes the clinical course of a 44-year-old woman who presented with this entity and was successfully corrected by surgical intervention. A discussion of diagnostic, operative, and prognostic considerations is presented.[ncbi.nlm.nih.gov]
Goiter
  • OBJECTIVE: This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal goiters and voluminous cervical goiter without thoracic extension.[ncbi.nlm.nih.gov]
Multiple Organ Dysfunction Syndrome
  • The patient was once again placed under inotropic support with noradrenaline but deteriorated day-by-day and developed multiple organ dysfunction syndrome due to sepsis. The patient died on the 17 th postoperative day.[scielo.br]
Mucosal Edema
  • A history of preceding upper respiratory tract infection may produce dyspnea in a patient with long-standing tracheal obstruction secondary to goiter through new laryngotracheal mucosal edema.[entokey.com]
Lower Extremity Pain
  • She denied chest pain, palpitations, wheezing, cough and hemoptysis, upper or lower extremities pain and swelling.[labome.org]
Tracheal Deviation
  • Chest radiographs showed tracheal deviation in 79 percent and soft tissue mass in 56 percent.[ncbi.nlm.nih.gov]
Expiratory Stridor
  • During the last four months he developed aggressive dyspnea, and in the recent two weeks he presented blue lips (cyanosis) and obvious obstructive symptoms including shortness of breath, inspiratory and expiratory stridor in awake, dyspnea and could not[cardiothoracicsurgery.biomedcentral.com]
  • Isolated expiratory stridor is seen in intrathoracic (lower tracheal) obstruction. Here, inspiration is silent and voice is normal.[entokey.com]
Respiratory Disorders
  • Surgery is indicated in case of malignancy or in cases with severe illness such as respiratory disorder and superior vena cava syndrome.[ncbi.nlm.nih.gov]
Foreign Body Sensation
  • Patients with cervical or substernal goiter may present with cough, dyspnea, foreign-body sensation, neck tightness, change in collar size, or wheezing and may come to the head and neck surgeon with a misdiagnosis of asthma or chronic obstructive pulmonary[entokey.com]
Chvostek Sign
  • sign (found in 10% of cases at baseline when eucalcemic) to determine if this reflex may be used to assess possible postoperative hypocalcemia.[emedicine.medscape.com]
Hyperhidrosis
  • RESULTS: The leading preoperative symptoms were dyspnea (49.2%), dysphagia (13.6%), hyperhidrosis (10.2%), and cardiac dysfunction (6.8%). All but two thyroid glands could be removed through a Kocher transverse collar incision.[ncbi.nlm.nih.gov]
Unable to Walk
  • The patient was unable to walk or sit because of the size of the goiter.[entokey.com]

Workup

  • This study was carried out to evaluate the clinical presentation, workup, surgical complications, and risk of malignancy for substernal goiter.[ncbi.nlm.nih.gov]
  • […] atteggiamento terapeutico il cui obiettivo e duplice: risolvere la sinto - matologia prodotta dalla massa mediastinica ed escludere la possibi - lita di recidive • We reviewed the cases of 52 patients with substernal goiters to examine clinical presentation, workup[scinapse.io]
  • In our centers, flow volume loop analysis is not part of the routine workup for goiter.[entokey.com]
  • Workup All patients underwent thyroid function test, US guided FNAC, USG neck, CECT scan, Thyroid scan. On FNAC, all patients were reported as benign nodular goiter. All patients were biochemically and clinically euthyroid.[medcraveonline.com]
Mediastinal Mass
  • A pulmonary perfusion defect was caused by an extremely large anterior mediastinal mass subsequently proved by I-131 imaging to be an intrathoracic extension of a cervical goiter.[ncbi.nlm.nih.gov]
  • More info Substernal Goiter: Rare Cause of Anterior Mediastinal Masses. Substernal Goiter: Rare Cause of Anterior Mediastinal Masses.[thyroidnosurgery.com]
  • Abstract: Substernal goiter remains a common consideration in the differential diagnosis of a mediastinal mass.[deepblue.lib.umich.edu]
Superior Mediastinal Mass
  • Goiters account for as many as 10–15% of space-occupying mediastinal lesions and are the most common of the superior mediastinal masses. Mediastinal goiters are classified as primary or secondary.[accesssurgery.mhmedical.com]
  • The results of the present study indicated that 100% of the findings obtained from chest x-ray had tracheal deviation, and in 100% of the findings obtained from CT scan, there were superior mediastinal mass, tracheal deviation and tracheal stenosis.[alliedacademies.org]
ST Elevation
  • A 76-year-old female, with a history of asthma and tracheal bronchitis, presented with a non-ST elevation, myocardial infarction.[ncbi.nlm.nih.gov]
Lymphocytic Infiltrate
  • Thyroid lobectomy also has a reported incidence of 18%-50%. [56, 57, 58, 59] Patients with Hashimoto thyroiditis and/or elevated anti-TPO antibody levels appear to be at an increased risk of hypothyroidism after thyroid lobectomy. [60] If lymphocytic[emedicine.medscape.com]

Treatment

  • In addition, even in those regions where they are less common, knowledge of their treatment is important as they can represent up to 7% of mediastinal tumors.[ncbi.nlm.nih.gov]

Prognosis

  • Treatment and prognosis Most anterior substernal thyroid goitres are accessed via a transcervical approach.[radiopaedia.org]
  • The prognosis depends on a good preoperative preparation and rigorous postoperative follow-up.[endocrine-abstracts.org]
  • Prognosis Benign goiters have a good prognosis. However, all goiters should be monitored by examination and biopsy for possible malignant transformation, which may be signaled by a sudden change in size, pain, or consistency.[emedicine.medscape.com]
  • CONCLUSION Prognosis in RSG is very good if diagnosed and treated in the proper time. Almost all the compressive symptoms completely disappear (as was seen in this case), mortality reported is near zero and morbidity is very low.[omjournal.org]
  • The apnea-hypopnea index can be instructive concerning prognosis and outcomes among critical patients in intensive care ( 13 ). Few clinical cases have been reported about OSAS caused by SVCS.[ncbi.nlm.nih.gov]

Etiology

  • Read Summary - More: Guidance 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis 01 August 2016 - Publisher: American Thyroid Association Thyrotoxicosis has multiple etiologies[evidence.nhs.uk]
  • EN In this article, the difficulties in treatment of 18 patients with intrathoracic thyroid goiters were discussed.The aim of the study were: defining the etiology and symptomology of goiters within the chest in the own material, conducting the analysis[psjd.icm.edu.pl]
  • Etiology of chylothorax in 203 patients. Mayo Clin Proc. 2005; 80 (7): 867-70[ DOI ][ PubMed ] 13. Simmgen M, Newlands ES, Southcott BM, Vigushin DM. Bilateral chylothorax due to retrosternal goiter in a patient with non-Hodgkin's lymphoma.[endometabol.com]
  • Key words: Cardiac surgical procedures, cardiopulmonary bypass/ adverse effects, coronary artery bypass, goiter, substernal/complications/ surgery, postoperative complications, respiratory distress syndrome, adult/ etiology/therapy, thyroidectomy, tracheal[ncbi.nlm.nih.gov]
  • Substernal goiters represent up to 7% of mediastinal tumors. [2] Etiology Most (85-95%) substernal thyroid masses represent benign goiter.[emedicine.medscape.com]

Epidemiology

  • The purpose of this study was to analyze the epidemiological, clinical and paraclinical profile of substernal goiter and the difficulties of management. MATERIAL AND METHODS: A retrospective study included 50 cases from our ENT department.[ncbi.nlm.nih.gov]
  • Epidemiology of nodular goitre. Influence of iodine intake. Best Pract Res Clin Endocrinol Metab 2014 Aug;28(4):465–79. [ CrossRef ] [ PubMed ] Nakaya M, Ito A, Mori A, et al. Surgical treatment of substernal goiter: An analysis of 44 cases.[edoriumjournalofsurgery.com]
  • Epidemiology The incidence of substernal goiter is difficult to assess but reportedly ranges from 2.6-21% of patients undergoing thyroidectomy. The wide range in reported incidence is largely due to variation in the definition of substernal goiter.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • […] intrathoracic goiter, thoracoscopic resection has also been reported. 8 Although the surgical resection can be complicated by intraoperative hemorrhage, major postoperative complications are rarely seen. 5 The use of CPB itself initiates a variety of pathophysiologic[ncbi.nlm.nih.gov]
  • Pathophysiology Substernal goiters are largely considered to result from the descent of a cervical goiter with the primary blood supply remaining in the neck, primarily from the inferior thyroid artery.[emedicine.medscape.com]
  • “Canine model to study exocrine pancreatic pathophysiology”. British Journal of Surgery, 1992; 79 (suppl.): S112. 17) Tocchi A, Basso L , Costa G, Lepre L, Liotta G, Mazzoni G. “Surgical treatment of duodenal diverticula”.[colonproctologia.com]

Prevention

  • This technique seems to offer improved exposure and reliable control of the neuro-vascular structures in the anterior mediastinum when resecting a huge substernal goiter that may prevent nerve injury.[ncbi.nlm.nih.gov]
  • Treatment consists of iodine replacement; although this will not cure the condition, it can stop it from enlarging, and iodine administered in advance will prevent development of goiter. exophthalmic goiter any type accompanied by exophthalmos . fibrous[medical-dictionary.thefreedictionary.com]
  • Asymptomatic patients with substernal goiter should also be considered for surgery to prevent complications [12] .[labome.org]

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