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

Aghajanzadeh, Manouchehr; Asgary, Mohammad Reza; Mohammadi, Fatemeh; Darvishi, Haniye; Safarpour, Yasaman

doi:10.4066/biomedicalresearch.29-17-1692

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…In [21]. Overall, the complication rate in our series was comparable to previous reports [22,23]. This makes sense considering that most cases were found in the anterior mediastinum, where anatomical disruption of the recurrent laryngeal nerve or parathyroid glands is unlikely to occur, both of which occur in the tracheoesophageal groove.…”

Section: Discussionsupporting

confidence: 85%

Surgical Management and Predictors of Postoperative Complications of Retrosternal Goiters: A Retrospective Study

Obadiel,

Al-Shehari,

Algmaly

et al. 2024

Cureus

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Background: The preferred standard treatment for retrosternal goiter (RSG), a slow-growing, often benign tumor, remains thyroidectomy. An alternative strategy may be required when the goiter is intrathoracic. Data on the results of RSG procedures are rarely reported. Careful patient selection and assessment are critical to avoiding an unexpected sternotomy during surgery and postoperative complications. This study aims to examine the clinical findings and treatment outcomes of RSG and to identify the variables affecting postoperative complications in a resource-limited setting.Method: A retrospective study was conducted at Al-Thawra Modern General Hospital in Sana'a, Yemen, on 69 patients diagnosed with RSG and undergoing thyroidectomy between April 2019 and February 2023. Initial clinical characteristics, radiological and laboratory findings, treatment approach, and outcome were collected from the patient's medical profile and analyzed. To determine the variables influencing postoperative complications, a bivariate analysis was carried out.Results: The mean age was 51.0 ± 13.6 years, and 45 (65.2%) were female. The most commonly reported symptoms were palpable masses (66; 95.7%), difficulty breathing (45; 65.2%), and neck discomfort (20; 29.0%), with 7 (10.1%) patients being asymptomatic. Previous thyroid surgery was reported in 10 (14.5%) cases. According to the grading classification, grade 1 was the most prevalent (42; 60.9%). Total thyroidectomy was the predominant surgical procedure in 59 (85.5%) cases. Using a cervical approach, all patients underwent thyroidectomy, and a sternotomy was required in one case. Histopathological analysis revealed benign multinodular goiter in 79.7%, followed by papillary thyroid cancer in 10.1% and thyroiditis in 6.7%. The postoperative complication occurred in 22 (31.9%), and the most common complication was transient hypocalcemia (11, 15.9%). There was no mortality during or after the surgery. In bivariate analysis, advanced age, difficulty swallowing, tracheal deviation, large RSG mass, advanced RSG grade, previous surgery, and malignant histopathology were associated with postoperative complications and were statistically significant (all p<0.05).Conclusion: RSG is a rare disease that may require challenging surgical intervention. In this study, the cervical approach was the most practical and least intrusive surgical method. In addition, postoperative complications were associated with advanced age, difficulty swallowing, tracheal deviation, large RSG mass, advanced RSG grade, previous surgery, and malignant histopathology. Low postoperative complication rates can be achieved by understanding the surgical architecture of the neck, essential clinical RSG presentation, thyroid pathology, and necessary surgical treatment.

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Section: Discussionsupporting

confidence: 85%

Surgical Management and Predictors of Postoperative Complications of Retrosternal Goiters: A Retrospective Study

Obadiel,

Al-Shehari,

Algmaly

et al. 2024

Cureus

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“…According to one study, 58.5% of the retrosternal goiters were multi-nodular goiter, 22.9% were papillary cell carcinoma, 7.1% were medullary carcinoma, 5.7% were combined anaplastic + papillary carcinoma, 5.7% were thyroid lymphoma, and only 1.4% were thyroid adenoma [ 9 ]. In our study, the main part of AMTTO histology was benign, as nodular micro- and macrofollicular goiter (15/20, 75%) was the most common histology.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of anterior mediastinal tumors of thyroid origin: a comprehensive analysis of approaches, techniques, and outcomes

Yankov,

Alexieva,

Yamakova

et al. 2024

J Cardiothorac Surg

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Background This manuscript aims to describe the symptoms, demographics, surgical approaches and techniques, the volume of surgical interventions, histological results, intra- and postoperative complications, and postoperative results in patients with anterior mediastinal tumors of thyroid origin (AMTTO). Methods Twenty patients with AMTTO were operated between 2017 and 2021. Fifteen were women and 5 were men. The mean age was 66.8 years. Results The most common histology was nodular micro- and macrofollicular goiter (15/20, 75%). Kocher cervicotomy (65%) was the preferred approach. Total thyroidectomy was performed in 95% of patients. Intraoperative complications were identified in 25% (5/20), and in 2 patients a tracheostomy was required. Early postoperative complications were established in 65% and the most common was unilateral transient recurrent nerve paresis or paralysis and dysphonia (25%). Conclusions Commonly resection of AMTTO is a challenge due to its complexities associated with high-risk cases, emphasizing the need for experienced centers in managing such cases.

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“…However, acute obstruc-tion causing significant symptoms and potentially endangering the patient's life remains a primary indication for urgent surgery. Acute dyspnea due to airway obstruction without local signs of thyroid enlargement in previously undiagnosed goiters remains a rarity (6). Such a clinical presenta-tion is rare, occurring in only up to 0.6% of cases (7).…”

Section: Discussionmentioning

confidence: 99%

Acute dyspnea following knee joint total endoprosthesis – a diagnostic surprise

Miletic,

Röschel,

Jovanovic

et al. 2023

FEM

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Acute dyspnea, sometimes dramatic, is most often caused by cardiovascular or respiratory disease. However, although rare, thyroid dysfunction may present a similar clinical picture with equally serious and life-threatening consequences. Therefore, every occurrence of acute dyspnea represents a special medical challenge in diagnosis and treatment. We present a case of 81-year-old male admitted to the rehabilitation department five days after a knee joint total endoprosthesis and developed acute dyspnea two days later. An emergency diagnostic was performed and confirmed an airway stenosis through a previously undiagnosed enlarged thyroid gland. Although in most cases an acute life-threatening postoperative dyspnea indicates a cardiac or pulmonary problem, other diseases must be taken into consideration.

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

Cited by 4 publications

References 3 publications

Surgical Management and Predictors of Postoperative Complications of Retrosternal Goiters: A Retrospective Study

Surgical Management and Predictors of Postoperative Complications of Retrosternal Goiters: A Retrospective Study

Surgical management of anterior mediastinal tumors of thyroid origin: a comprehensive analysis of approaches, techniques, and outcomes

Acute dyspnea following knee joint total endoprosthesis – a diagnostic surprise

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