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.
Humans ; Thyroidectomy/methods* ; Retrospective Studies ; Goiter, Substernal/pathology* ; Hypoparathyroidism/surgery*

Substernal goiter is defined as a thyroid mass of which more than half is located below the thoratic inlet. Substernal goiters must be removed surgically due to relation to compressive symptoms, potential airway compromise, and the possibility of an association with malignancy. Thyroidectomy for substernal goiter is usually carried out through a standard cervical approach. However, a few patients with various factors require an extracervical approach, usually by sternotomy. Recently, we successfully removed a substernal goiter that extended to the lower level of the aorta and tracheal carina though the combined cervical and video-assisted thoracoscopic approach. We present this case with a review of the literature.
Aorta ; Bays ; Chylothorax ; Goiter, Substernal* ; Humans ; Sternotomy ; Thoracic Surgery, Video-Assisted ; Thyroid Gland ; Thyroidectomy

Intrathoracic goiters consist of two types: the primary and secondary type. Primary intrathoracic goiters are very rare. We report here on a case that was resected with using the thoracoscopic assist technique. The transthoracic or transsternal approach is necessary for primary goiters to remove them completely without complications.
Goiter ; Goiter, Substernal ; Mediastinum

Composite tumors containing pheochromocytoma and ganglioneuroma are very rare. We report a 70-year-old female with papillary thyroid carcinoma and a compound adrenal medullary tumor, composed of pheochromocytoma/ ganglioneuroma. She had complained of epigastric discomfort 2 months earlier. Chest computed tomography and pancreatic magnetic resonance imaging revealed an intrathoracic goiter and pancreatic cystic tumor. She underwent an explorative laparotomy, and a left adrenalectomy was done because of an adrenal mass, not the pancreatic mass. The pathological diagnosis was a compound adrenal medullary tumor, composed of pheochromocytoma and ganglioneuroma. Although there was no evidence of thyroid cancer on fine needle aspiration cytology, a total thyroidectomy was done because of the neck discomfort. The pathological diagnosis was a papillary thyroid carcinoma, and she underwent radioactive iodine therapy.
Adrenalectomy ; Aged ; Biopsy, Fine-Needle ; Brain Stem Neoplasms ; Carcinoma ; Female ; Ganglioneuroma ; Goiter, Substernal ; Humans ; Iodine ; Laparotomy ; Magnetic Resonance Imaging ; Neck ; Pancreatic Cyst ; Pheochromocytoma ; Thorax ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

Substernal goiter is defined as a thyroid mass of which more than half is located below the thoracic inlet. As substernal goiter enlarges within the bony thoracic cavity, and vascular and visceral structures may slowly become compressed and compromised. Airway obstruction can occur due to the compression or the displacement of the trachea. Tracheal compression may rarely lead to severe respiratory compromise. Recently, we experienced a case of huge substernal goiter causing acute respiratory failure in a 63-year old female. We present this case with a review of the literature.
Airway Obstruction ; Bays ; Displacement (Psychology) ; Female ; Goiter, Substernal ; Humans ; Respiratory Insufficiency ; Thoracic Cavity ; Thyroid Gland ; Trachea

PURPOSE: The aims of this study were to introduce an alternative surgical technique using a ballooning catheter and assess the outcomes of its use in patients with an upper mediastinal mass originated from the thyroid gland. METHODS: Between May 2001 and April 2004, 8 patients undewent an operation via a cervical approach using a ballooning catheter were enrolled in this study. The study group was reviewed by their clinical characteristics, diagnostic methods, postoperative results, histopathological findings and prognosis. Instead of a sternotomy, a ballooning catheter technique was used to assist in the transcervical delivery and extraction of these huge or deep mediastinal masses. The ballooning catheter was placed at the base of the mediastinal mass via a narrow plane which could not be reached by the surgeon's fingers. When the mediastinal mass was freed up by careful dissection with traction using an inflated ballooning catheter, could the mass was able to be delivered without injury to the surrounding tissues. RESULTS: There were 3, 2 and 3 cases of substernal goiters, substernal goiters combined with a papillary microcarcinoma and metastatic papillary carcinoma from thyroid cancer, respectively. The mean operation time and period of hospitalization were 121 minutes, (ranging from 70 to 195 minutes), and 6 days, (ranging from 3 to 10 days), respectively. In the 5 cases with a substernal goiter, the average size of the resected specimen was 9.9 cm, (ranging from 5.5 to 17.6 cm), with an average weight of 100.2 g, (ranging from 45 to 172.2 g). In the 3 cases of metastatic mediastinal lymph nodes, the postoperative 131I scan and serum thyroglobulin level showed no evidence of remnant metastatic tissue or cancer spillage. The median follow up duration was 24.8 months (ranging from 13 to 42 months). No major complications were documented, and no evidence of recurrence was encountered. CONCLUSION: The use of the ballooning catheter was found to be helpful in the transcervical removal of an upper mediastinal mass, and useful for substernal goiters. Furthermore, for mediastinal lymph node metastasis, this technique can be adopted as an alternative method in carefully selected cases.
Carcinoma, Papillary ; Catheters* ; Fingers ; Follow-Up Studies ; Goiter, Substernal ; Hospitalization ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Sternotomy ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms ; Traction

OBJECTIVETo explore the Surgical approach and management of intrathoracic goiter.

METHODSSeventy patients were operated on for thyromegaly extending to the thorax in an 15-year period at the department of Head and Neck surgery, Cancer Hospital, Chinese Academy of Medical Sciences. The median age of the 70 patients (44 women and 26 men) was 55 years, with a range of 23 to 71 years. Sixty cases were benign intrathoracic goiter and ten cases were malignancy. To help choice of operative approach, the intrathoracic goiter was divided into three types to based on chest film, computed tomography or magnetic resonance imaging and clinical symptom. I type: the inferior extremity of goiter is on the aortic arch. II type is the goiter to enter intrathoracic and portion located behind aortic arch, or the goiter enter posterior mediastinum. For III type, intrathoracic goiter intrude thoracic cavity, or accompany superior vena caval syndrome. Operative method, surgical access and treatment effect were discussed in this essay.

RESULTSA cervical incision alone was performed in 62 cases (I type 41 cases, II type 21 cases), and sternotomy in 8 (II type 3 cases, III type 5 cases). There was low morbidity and no deaths. Removal rate by cervical approach for intrathoracic benign and malignant goiter were 95% (57/60) and 50% (5/10) respectively. The Complication rate of cervical approach was significantly lower (8.1%) than that sternotomy approach (37.5%, P < 0.01).

CONCLUSIONSMost cases of intrathoracic goiter can be managed by cervical incision alone. Only a few cases, a median sternotomy approach may be needed when adhesions or an anomalous blood supply are present or carcinoma is suspected.

Adult ; Aged ; Female ; Goiter, Substernal ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Neoplasms ; surgery ; Thyroidectomy ; methods ; Young Adult

BACKGROUND AND OBJECTIVES: Traditionally, approaches to the superior mediastinum for head and neck surgeons are mainly limited to stomal recurrence. Recently, the need to approach to the superior mediastinum is increasing due to increasing thyroid surgery by head and neck surgeon. This study was designed to evaluate the approaches to mediastinum in head and neck tumors involving the superior mediastinum and to analyse the outcome of surgery in terms of morbidity and mortality. MATERIALS AND METHODS: At the department of otolaryngology-head and neck surgery of Hallym university, 15 patients who had been diagnosed as head and neck tumors involving the superior mediastinum from May 1990 to August 1998 were evaluated retrospectively. RESULTS: Of the 15 patients, the tumors involving the superior mediastinum were thyroid cancer (5 cases), hypopharyngeal cancer (4 cases), cervical esophageal cancer (2 cases), laryngeal cancer (1 case), and substernal goiter (3 cases). The surgical techniques used for approach to the superior mediastinum were suprasternal approach, clavicle resection, median sternotomy, and sternal manubrium resection. Eight patients are alive without recurrence, one patient is alive with disease, and six patients died, among them, four patients died of postoperative complication and two died of recurrent cancer. CONCLUSION: The mediastinal approach in itself is not complex and dangerous, however, in the treatment of head and neck cancers involving mediastinum, the surgeon should be careful in choosing the surgical method and approach. The surgeion should also take into consideration morbidity and mortality of the surgery, degree of tumor invasion and others, such as age of the patient.
Clavicle ; Esophageal Neoplasms ; Goiter, Substernal ; Head* ; Humans ; Hypopharyngeal Neoplasms ; Laryngeal Neoplasms ; Manubrium ; Mediastinum* ; Mortality ; Neck* ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Sternotomy ; Thyroid Gland ; Thyroid Neoplasms

BACKGROUND AND OBJECTIVES: Substernal goiter, defined as any thyroid enlargement that has greater mass inferior to the thoracic inlet, is a relatively rare disease with a potential for malignancy and the risk of postoperative airway obstruction secondary to tracheomalacia. We investigated clinical characteristics of substernal goiters and analyzed the results of the treatment to establish modalities of the surgical management. MATERIALS AND METHODS: We examined, retrospectively, ten cases of substernal goiters and reviewed their clinical features, radiological findings, histopathologic findings, operative findings and postoperative complications. RESULTS: We found tracheal deviations in six patients, tracheomalacia in three patients and calcification in two patients. We performed partial thyroidectomy for 9 cases and total thyroidectomy and superior mediastinal dissection were done for a case which revealed to be follicular carcinoma. The main histopathologic findings were multinodular goiter in five cases, followed by follicular adenoma, and follicular carcinoma in one case. Endotracheal intubation was removed after 24 hours postoperatively for six cases who showed severe tracheal compression and tracheal deviation and the tracheopexy (tracheal suspension) to the sternum was performed for one case among them. CONCLUSION: Because of the possibilities of malignancy and the acute airway obstruction, the surgical treatment and careful postoperative airway management should be emphasized for substernal goiter.
Adenoma ; Airway Management ; Airway Obstruction ; Bays ; Goiter ; Goiter, Substernal* ; Humans ; Intubation, Intratracheal ; Postoperative Complications ; Rare Diseases ; Retrospective Studies ; Sternum ; Thyroid Gland ; Thyroidectomy ; Tracheomalacia

Substernal extension of a goiter into the thoracic inlet endows a generally benign neck mass with morbid potential. The reported incidence varies between 1% and 15% of all thyroidectomies performed. Whether all patients with a substernal goiter should undergo an operation or whether the operation should be performed selectively remains controversial. From May 1989 to March 1996, 10 patients underwent thyroidectomies for substernal goiters, and those cases of resected substernal goiters have been reviewed to access the symptoms and signs that brought patients to surgery: the size and the position of goiter, the preoperative work-up, the risk associated with the operation, and the histopathologic state of the goiter. There were 3 male and 7 female patients, and their ages ranged from 40 to 68 years. The chief complaints were cervical mass (4), dyspnea (2), facial edema (1) and chest pain (1). No symtomatic cases (2) were also found. The average mass size was 8.4 cm (5-14 cm) and the average weight was 109 gm (41-350 gm). Although chest film was the most used, computed tomography was by far the most useful study. Thyroid scans often failed to show the substernal goiter. Fine-needle aspiration was not helpful because of inaccessibility. In the majority of the patients (7 cases), the substernal goiters were removed by a cervical incision. Three cases of goiters located deep to the carina level required a combined cervical and sternotomy approach or thoracotomy. In the cervical incision group, the complications were transient hypocalcemia (1) and unilateral recurrent laryngeal nerve injury (1). In the combined cervical and sternotomy approach or thoracotomy, unilateral recurrent laryngeal nerve injury (1) and bilateral recurrent laryngeal nerve injury (1) and mediastinitis (1) were the complications. An occult papillary carcinoma, which was not identified preoperatively, was found in one case. Removal was almost always accomplished via cervical incision and with low morbidity and no deaths. Also, the substernal goiters revealed unusual symptoms and signs, such as dyspnea, facial edema and chest pain, compared to usual thyoid goiters and were relatively bigger in size. In conclusion, most substernal goiter above the carinal level could be removed by cervical incision with a low rate of complication. The threat of compression, the substantial chance of malignancy, and the safety of resection mean that the presence of a substernal goiter is an indication for surgery.
Bays ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Chest Pain ; Dyspnea ; Edema ; Female ; Goiter ; Goiter, Substernal* ; Humans ; Hypocalcemia ; Incidence ; Male ; Mediastinitis ; Neck ; Recurrent Laryngeal Nerve Injuries ; Sternotomy ; Thoracotomy ; Thorax ; Thyroid Gland ; Thyroidectomy