Goiter, Substernal
Goiter
Tracheal Stenosis
Goiter, Nodular
Goiter, Endemic
Iodine
Thyroid Gland
Fatal haematemesis due to benign retrosternal goitre. (1/28)
The development of a goitre in the retrosternal space may result in many different symptoms due to local compression. We describe a case in which such a goitre resulted in full-thickness ulceration of the oesophagus, which presented as a fatal haematemesis. We believe that such a complication has not been previously reported. (+info)Substernal goiter: an unusual cause of respiratory failure after coronary artery bypass grafting. (2/28)
Substernal goiter can cause extrathoracic upper airway obstruction. Since cardiopulmonary bypass results in a systemic inflammatory response syndrome characterized by an increase in capillary permeability and edematous changes in many tissues including the thyroid gland, an existing nonobstructive substernal goiter may become obstructive postoperatively. We describe the case of a patient with an asymptomatic substernal goiter who required urgent thyroidectomy for tracheal obstruction after elective coronary artery bypass grafting. To the best of our knowledge, ours is the 1st such case reported in the English-language medical literature. This case illustrates that, in cases of acute postoperative respiratory failure after open heart surgery, tracheal obstruction caused by enlarged substernal goiter should be considered in the differential diagnosis. (+info)Surgical management of substernal goitre: local experience. (3/28)
OBJECTIVES: To examine the presentation, workup, and surgical complications of substernal goitre. DESIGN: Retrospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: Twenty-four mostly elderly patients (mean age, 60.1 years) who underwent thyroidectomy for substernal goitres between 2000 and 2003 (substernal goitres were defined as those having either a caudal mass transgressing the fourth thoracic vertebra or having more than 50% of their overall mass residing within the thorax). MAIN OUTCOME MEASURES: Symptoms, histopathological diagnoses, morbidities, and complications. RESULTS: Dyspnoea was the most common symptom (n=8, 33%). Three (12.5%) patients presented with acute airway obstruction; however, 13 (54.2%) were asymptomatic apart from the presence of cervical masses. Computed tomographic scans were performed on all but two patients. Malignancy was present in 12.6% of patients, or 16.8% if occult papillary carcinoma is included. Partial or full sternotomies were performed in two (8.3%) patients. Complications included recurrent laryngeal nerve injury (n=1, 2.7% of nerves at risk), transient hypoparathyroidism (n=2, 13.3% of patients at risk), haematoma (n=1, 2.7%), pneumonia (n=1, 2.7%), and wound infection (n=1, 2.7%). There was no operative mortality or permanent hypoparathyroidism. The complication rate was significantly lower in the asymptomatic patients (P=0.033 by Fisher's exact test); clinicopathological parameters were otherwise statistically comparable between the two groups. CONCLUSIONS: There is rarely any mortality in thyroidectomy for substernal goitre, and the morbidity is also very low, especially in asymptomatic patients. In the absence of contra-indications, substernal goitre should be treated with early surgery rather than having it run the risk of acute airway distress or cancer. (+info)Retrosternal thyroid goiter: 15 years experience. (4/28)
BACKGROUND: Thyroidectomy for goiter is a common surgical procedure performed in most hospitals in Israel. Both general and ear, nose and throat surgeons are familiar with thyroidectomy for cervical goiters. In about 1-15% of thyroidectomies, the goiter is intrathoracic and requires somewhat different management. This topic has not been reviewed in the literature recently. OBJECTIVE: To evaluate the clinical presentation, preoperative workup, surgical complications and risk of malignancy in retrosternal goiters. METHODS: We retrospectively reviewed the records of 75 patients who underwent thyroidectomy for retrosternal goiter in the General Thoracic Surgical Department of our institution during a 15 year period, January 1990 to January 2005. RESULTS: All the patients (41 women and 34 men) were symptomatic at presentation, with choking and dyspnea being the most common complaint. Computerized tomography scan of the neck and chest were obtained before the operation in 71 patients (95%). Ten patients (13%) had a previous partial thyroidectomy. A cervical approach was used in 68 patients (91%). Seven patients (9%) required median sternotomy to complete the operation. One patient (1.3%) died from postoperative respiratory failure. Transient recurrent laryngeal nerve palsy occurred in 5 patients (7%) and permanent RLNP in 3 (4%). The incidence of transient and permanent hypoparathyroidism was 10% and 2.6% respectively. Sixty-six lesions (88%) were benign and 9 (12%) were malignant. CONCLUSIONS: Choking and dyspnea are the most common presenting symptoms of retrosternal goiter. CT scan is an important component of the preoperative evaluation and operative planning. Surgical removal of the thyroid is the treatment of choice and most patients have symptomatic improvement following the operation. Since a substernal thyroidectomy may be technically different from cervical thyroidectomy, a surgical team familiar with its unique pitfalls should perform the procedure. (+info)Intrathoracic goiter and invasive thymoma: rare concomitant presentation. (5/28)
We present a rare situation in which two mediastinal tumors of different topology and histology were found during the resection of an extensive mediastinal tumor in an asymptomatic patient. Different histologies within the same mass have been reported, although, to our knowledge, there have been no reports of different tumors at distinct locations. Thymomas and intrathoracic goiters account for a large proportion of the tumors found in the mediastinum. When feasible, surgical resection plays a fundamental role in effecting a cure. In order to identify concomitant lesions and perform a complete resection, detailed surgical exploration is required. (+info)Atrial septal defect and retrosternal toxic goitre operated in the same session: a case report. (6/28)
In this study, we present a 55-year-old female patient who suffered from atrial septal defect (ASD) and retrosternal toxic goitre simultaneously. The patient had been treated with a 300 mg/day dose of propylthiouracil for 20 days prior to operation. This patient has been operated on for both disorders and has recovered. (+info)Peak expiratory flow in the detection of retrosternal goitre. (7/28)
In 24 patients where the lower border of a cervical goitre was poorly defined, the value of simple lung function tests in the prediction of the presence of a retrosternal goitre was assessed. At operation there were nine patients with retrosternal extension (Group I) and 15 without (Group II). The preoperative PEF ratio (observed to predicted) was significantly different between the two groups (P = 0.004) with a positive predictive value of 90% for a retrosternal goitre. This difference was abolished after thyroidectomy. There was a significant improvement in PEF in patients with retrosternal goitres after thyroidectomy (P less than 0.001). It is concluded that the preoperative measurement of PEF is a simple method of detecting the retrosternal extension of a cervical goitre. (+info)Novel thoracoscopic approach to posterior mediastinal goiters: report of two cases. (8/28)
(+info)Substernal goiter refers to an enlarged thyroid gland that extends below the sternum or breastbone. It is also known as a retrosternal goiter. This condition can cause compression of surrounding structures such as the trachea and esophagus, leading to symptoms like difficulty swallowing, shortness of breath, and cough. Substernal goiters may be asymptomatic or may require treatment, including surgery, to alleviate symptoms and prevent complications.
Goiter is a medical term that refers to an enlarged thyroid gland. The thyroid gland is a small, butterfly-shaped gland located in the front of your neck below the larynx or voice box. It produces hormones that regulate your body's metabolism, growth, and development.
Goiter can vary in size and may be visible as a swelling at the base of the neck. It can be caused by several factors, including iodine deficiency, autoimmune disorders, thyroid cancer, pregnancy, or the use of certain medications. Depending on the underlying cause and the severity of the goiter, treatment options may include medication, surgery, or radioactive iodine therapy.
Tracheal stenosis is a medical condition characterized by the abnormal narrowing of the trachea (windpipe), which can lead to difficulty breathing. This narrowing can be caused by various factors such as inflammation, scarring, or the growth of abnormal tissue in the airway. Symptoms may include wheezing, coughing, shortness of breath, and chest discomfort, particularly during physical activity. Treatment options for tracheal stenosis depend on the severity and underlying cause of the condition and may include medications, bronchodilators, corticosteroids, or surgical interventions such as laser surgery, stent placement, or tracheal reconstruction.
A goiter is an abnormal enlargement of the thyroid gland, which is a butterfly-shaped endocrine gland located in the front of the neck. Goiters can be either diffuse (uniformly enlarged) or nodular (lumpy with distinct nodules). Nodular goiter refers to a thyroid gland that has developed one or more discrete lumps or nodules while the remaining tissue is normal or may also be diffusely enlarged.
Nodular goiters can be classified into two types: multinodular goiter and solitary thyroid nodule. Multinodular goiter consists of multiple nodules in the thyroid gland, while a solitary thyroid nodule is an isolated nodule within an otherwise normal or diffusely enlarged thyroid gland.
The majority of nodular goiters are benign and do not cause symptoms. However, some patients may experience signs and symptoms related to compression of nearby structures (such as difficulty swallowing or breathing), hyperthyroidism (overactive thyroid), or hypothyroidism (underactive thyroid). The evaluation of a nodular goiter typically includes a physical examination, imaging studies like ultrasound, and sometimes fine-needle aspiration biopsy to determine the nature of the nodules and assess the risk of malignancy. Treatment options depend on various factors, including the size and number of nodules, the presence of compressive symptoms, and the patient's thyroid function.
Esophagoplasty is a surgical procedure that involves reconstructing or reshaping the esophagus, which is the muscular tube that connects the throat to the stomach. This procedure may be performed to treat various conditions such as esophageal atresia (a birth defect in which the esophagus does not develop properly), esophageal stricture (narrowing of the esophagus), or esophageal cancer.
During an esophagoplasty, a surgeon may use tissue from another part of the body, such as the stomach or colon, to reconstruct the esophagus. The specific technique used will depend on the individual patient's needs and the nature of their condition.
It is important to note that esophagoplasty is a complex surgical procedure that carries risks such as bleeding, infection, and complications related to anesthesia. Patients who undergo this procedure may require extensive postoperative care and rehabilitation to recover fully.
Endemic goiter refers to a condition of abnormal enlargement of the thyroid gland that is prevalent in a particular geographic area due to deficiency of iodine in the diet or drinking water. The lack of iodine leads to decreased production of thyroid hormones, which in turn stimulates the thyroid gland to grow and attempt to increase hormone production. This results in the visible enlargement of the thyroid gland, known as a goiter. Endemic goiter is preventable through iodine supplementation in the diet or through iodized salt.
Esophageal stenosis is a medical condition characterized by the narrowing or constriction of the esophagus, which is the muscular tube that connects the throat to the stomach. This narrowing can make it difficult to swallow food and liquids, leading to symptoms such as dysphagia (difficulty swallowing), pain or discomfort while swallowing, regurgitation, and weight loss.
Esophageal stenosis can be caused by a variety of factors, including:
1. Scarring or fibrosis due to prolonged acid reflux or gastroesophageal reflux disease (GERD)
2. Radiation therapy for cancer treatment
3. Ingestion of corrosive substances
4. Eosinophilic esophagitis, an allergic condition that affects the esophagus
5. Esophageal tumors or cancers
6. Surgical complications
Depending on the underlying cause and severity of the stenosis, treatment options may include medications to manage symptoms, dilation procedures to widen the narrowed area, or surgery to remove the affected portion of the esophagus. It is important to seek medical attention if you experience any difficulty swallowing or other symptoms related to esophageal stenosis.
Thyroidectomy is a surgical procedure where all or part of the thyroid gland is removed. The thyroid gland is a butterfly-shaped endocrine gland located in the neck, responsible for producing hormones that regulate metabolism, growth, and development.
There are different types of thyroidectomy procedures, including:
1. Total thyroidectomy: Removal of the entire thyroid gland.
2. Partial (or subtotal) thyroidectomy: Removal of a portion of the thyroid gland.
3. Hemithyroidectomy: Removal of one lobe of the thyroid gland, often performed to treat benign solitary nodules or differentiated thyroid cancer.
Thyroidectomy may be recommended for various reasons, such as treating thyroid nodules, goiter, hyperthyroidism (overactive thyroid), or thyroid cancer. Potential risks and complications of the procedure include bleeding, infection, damage to nearby structures like the parathyroid glands and recurrent laryngeal nerve, and hypoparathyroidism or hypothyroidism due to removal of or damage to the parathyroid glands or thyroid gland, respectively. Close postoperative monitoring and management are essential to minimize these risks and ensure optimal patient outcomes.
Iodine is an essential trace element that is necessary for the production of thyroid hormones in the body. These hormones play crucial roles in various bodily functions, including growth and development, metabolism, and brain development during pregnancy and infancy. Iodine can be found in various foods such as seaweed, dairy products, and iodized salt. In a medical context, iodine is also used as an antiseptic to disinfect surfaces, wounds, and skin infections due to its ability to kill bacteria, viruses, and fungi.
The thyroid gland is a major endocrine gland located in the neck, anterior to the trachea and extends from the lower third of the Adams apple to the suprasternal notch. It has two lateral lobes, connected by an isthmus, and sometimes a pyramidal lobe. This gland plays a crucial role in the metabolism, growth, and development of the human body through the production of thyroid hormones (triiodothyronine/T3 and thyroxine/T4) and calcitonin. The thyroid hormones regulate body temperature, heart rate, and the production of protein, while calcitonin helps in controlling calcium levels in the blood. The function of the thyroid gland is controlled by the hypothalamus and pituitary gland through the thyroid-stimulating hormone (TSH).