A retrosternal goitre is an enlarged thyroid gland extending into the mediastinum. Retrosternal goitre is diagnosed when 50% of the thyroid gland lies below the thoracic inlet. The Presence of RG is documented in 2-19% of all thyroidectomies. Most retrosternal goitres are situated in the anterior mediastinal compartment. Posterior mediastinal goitres are uncommon, comprising 10-15% of all mediastinal goitres. The rate of malignancy in reported surgical series is low (6-21%). Large retrosternal goitre may cause airway and oesophageal compression. Therefore surgery will be indicated when the diagnosis is confirmed. This report describes a rare case of massive multinodular retrosternal goitre which was surgically removed using a combined cervical/sternotomy approach. Massive long-standing goitres are common in iodine-deficient areas. Retrosternal goitres are more common among women, the symptoms are related to compression of the airways and pressure on mediastinal structures. One of the most reliable classifications is the one considering the degree of the intrathoracic extension of the thyroid gland:
- Largely intrathoracic (more than 80 %)
- Partially intrathoracic (more than 50%, but less than 80 %)
- Sub sternal goitre (more than 50% remaining in the neck)
Surgical removal of a retrosternal goitre is a challenging procedure; the Cervical approach is suitable for 95%. The need for sternotomy increases greatly if a significant proportion of the gland is located in the mediastinum or the RG is in a retrotracheal or retroesophageal position, or if the intrathoracic component is significantly larger than the cervical one. Retrosternal goitre is a rare condition. CT scan should always be included in the pre-operative diagnostic workup when Retrosternal goitre is suspected Surgical removal is the treatment of choice in such cases. Combined cervical collar incision and sternotomy give good exposure and make it easy to remove large retrosternal goitres.
Keywords: Goitre, Mediastinal goitre, Sternotomy, Cervical
