Abstract

Retrosternal goitre was first described by Albrecht von Haller in 1749, as the extension of the thyroid tissue below the upper opening of the chest. Retrosternal goitre is most commonly defined as one that either descends below the thoracic inlet, or has more than 50% of its volume below this level. Retrosternal Goitres can be classified as either primary or secondary. Most retrosternal goitres can be removed through a cervical approach, while a partial or total sternotomy should be performed only in a minority of patients, ranging between 1-11%. Aims & Objectives: Retrosternal goiter may cause symptoms of airway obstruction and dysphagia, but often it is asymptomatic and is increasingly detected incidentally with imaging investigations. Consensus has been reached that sternotomy is not necessary in most cases, as a collar incision normally suffices. Our retrospective study was to analyse personal experience in the surgical management of retrosternal goitres, defining, in particular, the features requiring sternotomy. Materials and Methods: This is a Retrospective study comprising of 45 patients who underwent thyroidectomies between period of 2015-2022 in department of surgical oncology NIMS HYD. The patients with were analyzed further, with regard to demographics, presentation, indications, and outcome of surgical treatment and HPE reports. Results: A total of 45 patients with 11 male & 34 female patients with Mean age 50 yrs (Age range 22- 75). Most common presentation was neck swelling 68%, followed by respiratory symptoms. Surgical procedure predominantly done was near total thyroidectomy. Tracheostomy was done in 7 cases. In all cases recurrent laryngeal nerve identified and preserved. In 43 cases retrosternal goitre was removed by transcervical approach & sternotomy was needed in only 2 cases. Final histological diagnosis revealed malignancy in 6 cases (4 Papillary & 2 follicular ca). No intra or perioperative deaths occurred. Discussion: All patients who presented to department of surgical oncology NIMS Hyd. with thyroid swelling were clinically examined and patients in whom lower border of swelling was not palpable were considered to have retrosternal extension and were further evaluated using CXR, HRUS AND CT. Conclusion: In our experience surgical approach for retrosternal goitre should be determined by type of retrosternal extension (ectopic) and cytomorphology. Transcervical approach is gold standard in exploring the retrosternal extent of goitre. meticulous digital dissection should be carried out by the experienced surgeon. In cases where goitre extension in to thoracic cavity is bilateral and in malignancies sternotomy should be considered for excellent exposure and for reducing complications

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