నైరూప్య

An investigation into symptoms, diagnosis, treatment, and treatment complications in patients with retrosternal goiter

Manouchehr Aghajanzadeh, Mohammad Reza Asgary, Fereshteh Mohammadi, Haniye Darvishi, Yasaman Safarpour

Introduction: Retrosternal goiter refers to any thyroid enlargement in which over 50% of the thyroid permanently located under the thoracic inlet or the lower pole of thyroid is not palpable with the neck in hyperextended position. Due to the increasing number of surgical procedures of retrosternal goiter, the present study was carried out in order to examine the symptoms, diagnosis, treatment, and treatment complications in retrosternal goiter patients in Razi and Aria Hospitals, Rasht, Iran.

Material and Methods: In this retrospective cross sectional descriptive study, between 2007 and 2013, from 777 patients who had undergone thyroidectomy, 70 patients (9%) had retrosternal goiter. The medical records for 70 patients were retrospectively investigated. Data related to demographic, clinical symptoms, methods of diagnosis and postoperative complications were collected.

Results: According to the results of the present study, 71.4% patients were women and most of the participants (67.1%) aged 45 to 60 y. Mass in the neck was the most frequent symptoms before surgery (88.6%). Total thyroidectomy was most common surgery (74.3%). The most common incision for thyroidectomy (95/7%) was neck collar incision. Diagnosis method in 82.9% and 17.1% of cases was respectively based on CT scans with CXR and CT scans with CXR and ultrasound. According to the postoperative pathologic findings, 58.5% of the cases were multi-nodular goiter, 22.9% were papillary cell carcinoma, 7.1% were medullary carcinoma, 5.7% were anaplastic carcinoma, 5.7% were thyroid lymphoma, and only 1.4% were thyroid adenoma. Postoperative complications occurred in 47.14% of patients. Most common complication was early transient dysphonia. Permanent hypocalcemia were not observed in any patient.

Conclusion: This study recommends that retrosternal goiter should be operated early under suitable conditions, and the best diagnosis tool and best surgery methods are CT scan and surgery with collar incision, respectively.