See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/341323372 Clinical Presentation and Surgical Treatment of Retrosternal Goiter: A Case Series Study Article in Qatar Medical Journal · May 2020 DOI: 10.5339/qmj.2020.13 CITATIONS READS 0 25 5 authors , including: Hassan Althani Maryam Al-Sulaiti Hamad Medical Corporation Hamad Medical Corporation 329 PUBLICATIONS 1,631 CITATIONS 17 PUBLICATIONS 66 CITATIONS SEE PROFILE SEE PROFILE Abdelhakem Tabeb Ayman El-Menyar Hamad Medical Corporation Weill Cornell Medicine in Qatar 12 PUBLICATIONS 84 CITATIONS 439 PUBLICATIONS 3,048 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Young Kids In Safe Seats (Y-KISS) - Qatar Program: A Randomized Study to Increase Child Restraint Use in Qatar : Qatar Foundation National Research Priorities Grant # 7 - 1681 - 3 - 429 View project Organ Donation View project All content following this page was uploaded by Hassan Althani on 19 May 2020. The user has requested enhancement of the downloaded file.
RESEARCH ARTICLE Clinical Presentation and Surgical Treatment of Retrosternal Goiter: A Case Series Study Husham Abdelrahman 1 , Hassan Al-Thani 2 , Maryam Al-Sulaiti 2 , Abdelhakem Tabeb 2 , Ayman El-Menyar 3,4 ABSTRACT Background: The retrosternal goiter (RSG) is a slow-growing mass often benign in nature; Address for Correspondence: thyroidectomy remains the preferred standard Ayman El-Menyar 1 Trauma Surgery Section, Hamad General Hospital curative treatment. This study aimed to explore the (HGH), Doha, Qatar local experience of RSG with respect to the clinical 2 Department of Surgery, Hamad General Hospital presentation, classifications, management, and (HGH), Doha, Qatar outcomes. 3 Clinical Research, Trauma & Vascular Surgery Section, Method: A retrospective chart review was Hamad General Hospital (HGH), Doha, Qatar conducted to include all cases diagnosed with RSG 4 Clinical Medicine, Weill Cornell Medical College, and underwent thyroidectomy between January Doha, Qatar 1998 and December 2013. Email: aymanco65@yahoo.com Results: A total of 1210 patients underwent thyroidectomy; of which 30 (2.5%) patients were diagnosed to have RSG. The commonly reported symptoms were dyspnea (40%), pain and discomfort http://dx.doi.org/10.5339/qmj.2020.13 (30%), dysphagia (26.7%), and hoarseness (20%). Submitted: 23 October 2019 Thirteen patients (43.3%) were completely Accepted: 1 December 2019 asymptomatic. The fine-needle aspiration cytology ª 2020 Abdelrahman, Al-Thani, Al-Sulaiti, Tabeb, El-Menyar, was performed in 22 (73.3%) patients, of whom licensee HBKU Press. This is an open access article distributed the majority was benign (77.3%). The grading under the terms of the Creative Commons Attribution license CC BY 4.0, which permits unrestricted use, distribution and classification showed that grade 1 is the most reproduction in any medium, provided the original work is frequent (73.3%). Total bilateral thyroidectomy was properly cited. the most prevailing procedure in 57% cases followed by partial thyroidectomy. All patients underwent retrosternal thyroidectomy through a cervical incision Cite this article as: Abdelrahman H, Al-Thani H, except for one case. Postoperative histopathology Al-Sulaiti M, Tabeb A, El-Menyar A. Clinical Presentation and Surgical Treatment of showed frequent benign multinodular goiter (83.3%), Retrosternal Goiter: A Case Series Study, followed by papillary thyroid cancer (10%) and Qatar Medical Journal 2020:13 thyroiditis (6.7%). The most common complication http://dx.doi.org/10.5339/qmj.2020.13 after thyroidectomy was tracheomalacia (13.4%), transient hypocalcemia (10%), and hypoparathyroidism (6.7%). There was no intraoperative or perioperative mortality. Conclusion: RSG is a rare entity often presented with pressure symptoms, mostly involving anterior VOL. 2020 / ART. 13 1 QATAR MEDICAL JOURNAL
Retrosternal goiter and surgical management Abdelrahman et al. mediastinum and had a challenging surgical procedure. if symptomatic or suspicious for malignancy and have A large multicenter study is needed to include a wide range of incidence in the current literature. more cases in order to have a consensus on the Regardless of the underlying etiology, which is mostly benign, RSG is usually approached surgically. 13,14 definition and classification system for such important clinical goiter presentation. However, it remains controversial whether most or selective RSG cases require surgical intervention. 12 As regional data are scarce on such a rare disorder, we Keywords: retrosternal goiter, thyroid gland, surgical aim to present our experience of RSG to explore the intervention, outcome, surgery, endocrine demographic characteristics, clinical presentation, INTRODUCTION classifications, management, and outcomes of this thyroid entity in a tertiary care hospital. This will The thyroid gland is anatomically located in the neck increase the awareness of junior clinicians. This case region. When it gets localized or generalized series has been reported in line with the PROCESS hypertrophy, it is referred to as goiter. The natural criteria. 15 history of goiter is suggestive of the slow development of symptoms and progressive METHOD enlargement with subsequent obvious neck swelling, A case series with a retrospective chart review was pressure symptoms, or secondary hormonal dysfunctions. 1 The most frequently reported conducted to include all cases diagnosed with RSG and underwent thyroidectomy at our institute symptoms are dyspnea, choking, sleep discomfort, between January 1998 and December 2013. The dysphagia, and hoarseness, which are mainly related to the airway and esophageal compression. 2 The records of these patients were analyzed with regard to the demographics (age and gender), clinical thyroid gland upon enlargement may extend down presentation (asymptomatic, dyspnea, pain, and into the mediastinum, and if more than 50% of the dysphagia), comorbidities, personal and family history mass extended into the mediastinum, it is described as retrosternal (or substernal) goiter. 2 Because of the of cancer, radiological imaging (ultrasonography, radioactive iodine study, computed tomography [CT] diversity in the definition of substernal goiters, the reported rates vary greatly between 5% and 22%. 1 scan, and magnetic resonance imaging [MRI]) and fine-needle aspiration cytology (FNAC; These are often identified in the anterior mediastinum ultrasound-guided and clinic) findings, RSG and rarely in the posterior mediastinum, which is an important consideration for planning the surgery. 3,4 classification, operation type (primary or reoperation), surgical approaches (cervical, complete sternotomy, Because of slow mass expansion, retrosternal goiter and manubriotomy), excision type (total (RSG) often remains asymptomatic and is detected incidentally upon radiological investigation. 5 The thyroidectomy, hemithyroidectomy, and subtotal thyroidectomy), and clinical followup. All cases were diagnostic workup of RSG considered clinical history, physical examination, and radiological investigation. 6,7 investigated by a standard workup, and surgeries were conducted by an experienced surgical team. The There are many definitions and classification of the outcomes included the hospital and ICU length of stay, RSG. The commonly used definition considers that postoperative complications, and mortality (30 days more than half (or majority) of the gland extends beyond the thoracic inlet, 8,9 whereas other definitions and on followup). The Huins grading and anatomical specify any part of the gland 10,11 or even refer to the classification system were utilized for our RSG cases. 16,17 An RSG was diagnosed based on any goiter need for mediastinal exploration to fulfill the diagnosis. 12 Moreover, in some occasions, it might be reported by the preoperative or intraoperative report to extend to the thorax through the thoracic inlet. 10 ectopic (true mediastinal aberrant intrathoracic The institutional review board (IRB# 14197/14) thyroid tissues from birth [congenital] with unique and has approved and granted exempt status for this different vascular supplies) that may explain the retrospective study. wide difference in the reported incidence in literature; that is why some authors advocate the name Statistical analysis primary mediastinal goiter for the ectopic and Data were reported as proportion, mean ( ^ standard secondary for the extending goiters. Patients with deviation), median, and range, when applicable. Data RSG are primarily managed by surgical intervention 2 QATAR MEDICAL JOURNAL VOL. 2020 / ART. 13
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