Retrosternal Thyroid with Mediastinal Extension: Surgical Approach and Management

Sharmistha Chakravarty; Nitin M Nagarkar; Amritava Ghosh; Rupa Mehta

doi:10.1007/s12070-022-03231-w

Retrosternal Thyroid with Mediastinal Extension: Surgical Approach and Management

Indian J Otolaryngol Head Neck Surg. 2023 Jun;75(2):332-337. doi: 10.1007/s12070-022-03231-w. Epub 2022 Nov 6.

Authors

Sharmistha Chakravarty¹, Nitin M Nagarkar¹, Amritava Ghosh², Rupa Mehta¹

Affiliations

¹ Department of ENT & Head Neck Surgery, All India Institute of Medical Sciences, G.E Road, Tatibandh, Raipur, C.G 492099 India.
² Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, G.E Road, Tatibandh, Raipur, C.G 492099 India.

Abstract

To assess the clinical presentation and the need for sternotomy as an additional approach for surgical excision of goitre with retrosternal extension. It was a retrospective review of 22 patients (13 female, 9 male; mean age: 50.36 years) who underwent total thyroidectomy for retrosternal extension. Between-group differences were assessed using Chi-square or Fisher exact test, appropriate P values < 0.05 were considered indicative of statistical significance. All cases were assessed by CT scan of neck and thorax to confirm mediastinal extension. The symptoms most commonly reported were dyspnoea 6 (27%), hoarseness (13%) and dysphagia 2 (9%). The retrosternal extent was grade 1(thoracic inlet to aortic arch) in 11 cases and grade 2(aortic arch to pericardium) in 11 cases. Overall, 13 (59%) patients showed CT evidence of tracheal deviation. Patients were divided into two groups based on the surgical approach: trans-cervical (n = 13) and trans-cervical plus trans-sternal (n = 9). The radiological extent of retrosternal descent of goitre in the mediastinum showed no significant correlation with the requirement of sternotomy in our cohort (odds ratio for sternotomy in grade 2 extension: 1.45). The need for sternotomy in cases of retrosternal thyroid does not depend on the radiological extent of tumour alone. It depends on multitude of factors like presence of dysphagia, dyspnoea or hoarseness. Preservation of recurrent laryngeal nerve and parathyroid glands is difficult in the restricted thoracic inlet space. Sternotomy is required for complete excision and preservation of major mediastinal vessels.

Keywords: Mediastinum; Retrosternal goitre; Sternotomy; Thoracic inlet; Thyroidectomy.

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