[…] patients, as previously noted, have no significant palpable cervical abnormality, 3% to 7% present with vocal cord paralysis, and 4% to 50% are asymptomatic at presentation. [entokey.com]

Patients with a massive retrosternal goitre (mRSG) may present difficulties with airway management. [academic.oup.com]

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]

Other modes of presentation include neck mass (75%), hoarseness of voice (37.5%), dysphagia (31.3%), stridor/wheezing (19%), or SVC obstruction (6.25%). 5 The clinical presentation and the hormonal assay showed an euthyroid state in the studied patient [omjournal.org]

• Goiter

  Posterior mediastinal goiters are uncommon comprising 10-15% of all mediastinal goiters [15]. [medcraveonline.com]

  Conclusion: Choking and dyspnea are the most common symptoms of substernal goiter. [thyroidworldcongress.com]

  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]

• Plethora

  Facial plethora (Pemberton's sign), however, was marked within one minute after the patient raised both arms. The patient's intact parathyroid hormone (PTH) level was 59.99 pg/mL, total calcium was 9.3 mg/dL, and phosphorous was 3.7 mg/dL. [jes-online.org]

  Pemberton sign or “thyroid cork” describes the physical manifestation of marked facial plethora resulting from jugular vein compression when the thoracic inlet rises so that it is temporarily filled by a large substernal goiter (5). [ajnr.org]

  Distended neck veins and facial plethora are late findings in most cases yet these may be reproduced by having the patient raise both arms over head forcing the thyroid into the thoracic inlet, Pemberton's sign. [optecoto.com]

  Wax and Briant have noted that, with careful questioning, up to one third of patients who are “asymptomatic” admit to symptoms. 88 Pemberton’s sign is described as the development of head and neck venous engorgement with facial congestion, plethora, and [entokey.com]

• Tracheal Deviation

  Chest radiographs showed tracheal deviation in 79 percent and soft tissue mass in 56 percent. [ncbi.nlm.nih.gov]

  […] compression, and deviation. [academic.oup.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]

• Constipation

  […] hormone, an increase in oxygen consumption, metabolic changes in protein metabolism, immunologic stimulation of diffuse goitre, and ocular changes (exophthalmos).[4] Hypothyroid individuals may have weight gain despite poor appetite, cold intolerance, constipation [en.wikipedia.org]

  […] persists Hyperthyroid Symptoms Weight loss, heat intolerance, trembling hands, palpitations, insomnia, anxiety, increased bowel movement frequency - especially if the symptoms are new or persistent Hypothyroid Symptoms Weight gain, cold intolerance, constipation [endocrine.surgery.ucsf.edu]

  […] to hyperthyroidism (eg, palpitations, irregular or rapid heart rates, weight loss, increased heat sensitivity, insomnia, nervousness, tremulousness, diarrhea) or even hypothyroidism (eg, fatigue, weight gain, increased cold sensitivity, depression, constipation [emedicine.medscape.com]

• Thrombosis

  Computed tomography (CT) scan revealed a compressive substernal goiter with associated vascular compression, axillosubclavian thrombosis, and saddle pulmonary embolism. [miami.pure.elsevier.com]

  Venous congestion and thrombosis of the superior vena cava and its branches are rare. Surgical intervention in early stage is the key of treatment. Figure 1. [labome.org]

  Patients that required substernal thyroidectomy had increased odds of several postoperative complications: hemorrhage/hematoma, respiratory failure, pulmonary embolism/deep venous thrombosis, hypoparathyroidism, hypocalcemia, collapsed lung, bloodstream [thyroid.org]

  Axillosubclavian vein thrombosis produced by GH Santos - 1990 - 24 Aug 2009 ... secondary to ***substernal goiter.'” [translatorscafe.com]

  ( 20109623 ) Shaha A.R. 2010 29 Management of the substernal goiter: a team approach. ( 20830956 ) Cannon C.R....Didlake R. 2010 30 Superior vena cava syndrome and substernal goiter. ( 20151836 ) 2010 31 Incidental detection of internal jugular vein thrombosis [malacards.org]

• Cyanosis

  Prior to intubation the patient also presented cyanosis and edema of the head and upper extremities. [scielo.br]

  A positive Pemberton's sign is marked by the presence of facial congestion and cyanosis, as well as respiratory distress after approximately one minute. [3] Causes [ edit ] A positive Pemberton's sign is indicative of superior vena cava syndrome (SVC) [en.wikipedia.org]

  On physical examination, excessive edema and cyanosis in upper chest wall and head-neck area were found out. His neck was short and thick with restricted movements. [ncbi.nlm.nih.gov]

  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]

• Osteoporosis

  Updated clinical guidelines for diabetes, lipid disorders, obesity management, osteoporosis, and more, as well as essential treatment updates for the medical management of acromegaly, Cushing's Disease, hypercalcemia, and diabetes mellitus. [books.google.de]

  Bone densitometry: This is indicated if the patient has a long history of thyrotoxicosis or other risk factors for osteoporosis, such as in peri- and post-menopausal women. [endocrinologyadvisor.com]

  Lifelong suppression is required and such long-term TSH suppression therapy is associated with increased risk for adverse side effects such as atrial fibrillation and osteoporosis—especially in postmenopausal women (7,9–11). [liebertpub.com]

• Neck Mass

  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%). [ncbi.nlm.nih.gov]

  Further chapters focus on such topics as the role of ultrasound after thyroid surgery and ultrasound diagnosis of parathyroid disease, recurrent goiter, and neck masses. [euro-libris.ro]

  The patient, a 50-year-old male, had increasing exertional dyspnea and noticed an enlarging neck mass. A CT scan of the neck and chest suggested the presence of a substernal goiter extending inferiorly to the aortic arch and compressing the trachea. [jstage.jst.go.jp]

  Hypothyroid infant with neck mass. Thy- roid scan (anterior view) shows prominent uptake within the midline neck mass. There is no thyroid uptake in the region of thyroid bed. Box 6-6. [passeidireto.com]

This study was carried out to evaluate the clinical presentation, workup, surgical complications, and risk of malignancy for substernal goiter. [ncbi.nlm.nih.gov]

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]

[…] 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]

This discordance requires further workup to exclude malignancy. FigurE 6-19. Colloid goiter. Clinically palpable goiter in a patient who grew up in a Michigan goiter belt. Inhomogeneous tracer distribution with multiple focal cold areas. [passeidireto.com]

• Mediastinal Mass

  More info Substernal Goiter: Rare Cause of Anterior Mediastinal Masses. Substernal Goiter: Rare Cause of Anterior Mediastinal Masses. [thyroidnosurgery.com]

  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]

  The 24-hour iodine uptake of the thyroid gland (excluding the mediastinal mass) was slightly low at 10.9%. [healio.com]

• 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]

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]

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 No studies are available regarding the natural history of substernal goiter, nor those that compare expectant monitoring with surgery. [1] Complications Complications of untreated substernal goiters occur primarily because of compression of [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]

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]

Hypothyroidism has multiple etiologies and manifestations. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions. [aace.com]

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]

ETIOLOGY Iodine deficiency is the most common cause of goiter worldwide. [uptodate.com]

Substernal goiters represent up to 7% of mediastinal tumors. [5] In general, the diagnosis is made in individuals older than 50 years, and has a female predominance four-fold over males. [1] Etiology Most (85-95%) substernal thyroid masses represent benign [emedicine.medscape.com]

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 The incidence of substernal goiter is difficult to assess but reportedly ranges from 0.2% to 45% of patients undergoing thyroidectomy. [2] The wide range in reported incidence is largely due to variation in the definition of substernal goiter [emedicine.medscape.com]

OF PERITONITIS Medecine et maladies infectieuses BORGONOVO G; AMATO A; VARALDO E; MATTIOLI FP EPIDEMIOLOGY OF PERITONITIS Medecine et maladies infectieuses ARNOLDI A; BASSOLI A; BORGONOVO G; MERLINI L SYNTHESIS AND SWEET TASTE OF OPTICALLY-ACTIVE (-) [serials.unibo.it]

Pathophysiology The pathophysiology of goiters is well described in the Medscape Drugs and Diseases article Nontoxic Goiter. [emedicine.medscape.com]

[…] 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]

Essentials of pathophysiology: Concepts of altered health states (3rd ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. ^ Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson (2007). [en.wikipedia.org]

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]

Downward migration of the thyroid into the mediastinum is facilitated by negative intra-thoracic pressure, gravity, traction forces during swallowing and the presence of anatomical barriers preventing the enlargement in other directions (thyroid cartilage [slideshare.net]

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]