Indications for Surgery and Technical Peculiarities of Thyroidectomy in Patients With Retrosternal Goiter

Abstract

The paper is devoted to determining the frequency, features of the clinical course and technique of safe thyroidectomy in patients with retrosternal goiter. Materials and methods. We analyzed the treatment of 26 patients with retrosternal goiter. All patients underwent the neck-approach thyroidectomy with the identification of the recurrent laryngeal nerve during surgery. Results. It was found that patients with Graves’ disease did not have retrosternal goiter, with mixed toxic goiter the frequency was 13.7%, with nodular euthyroid goiter – 26.1%. In 11.5% of patients with retrosternal goiter, the diagnosis was made by chest x-ray, in 76.9% - by ultrasound imaging, in 19.2% - by CT imaging. Of the 26 patients, 1 (3.8%) was hospitalized urgently due to respiratory failure and compression syndrome, and 25 (96.2%) were admitted as planned. Operations in 25 (96.2%) were performed under endotracheal, in 1(3.8%) – under mask anesthesia. Intraoperatively, it was found that the location of the recurrent laryngeal nerve changed in the case of chest goiter that required special care when mobilizing the posterior surface of the thyroid gland from the trachea in the zone of the lower thyroid artery and in Berry ligament. Technical manipulations aimed at preventing damage to the recurrent laryngeal nerve at different stages of thyroidectomy are proposed. Conclusion. The results of operations in patients with substernal goiter show that if it is carefully performed and the recurrent laryngeal nerve is preserved, the postoperative period does not differ from that in the usual location of the thyroid gland and even relieves, since the compression syndrome is eliminated.