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1 Polish Journal of Surgery

1 2010

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Intrathoracic Thyroid Goiters

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Jabłoński S. , Wawrzycki M. , Brocki M. , Filgus M. , Kordiak J.

Polish Journal of Surgery

2010

tom 82

nr 2

69-76

In this article, the difficulties in treatment of 18 patients with intrathoracic thyroid goiters were discussed.The aim of the study were: defining the etiology and symptomology of goiters within the chest in the own material, conducting the analysis of the diagnostic efficiency, the evaluation of the early results of surgery and postoperative complications.Material and methods. The research material included 18 patients with intarhoracic thyroid goiters after surgical treatment (mediastinal goiters, ectopic goiters). The cases of retrosternal goiters were not analyzed. There was carried out the retrospective analysis of the medical documentation of goiters etiology, the frequency of dominating clinical symptoms, value of diagnostic methods, early effects of surgical treatment and postoperative complications.Results. In the years 2004-2008, operations were performed on 14 women and 4 men with intrathoracic goiters, aged from 34 to 82. The average age of patients was 51.1. The etiology of intrathoracic thyroid goiters were as follows: thyroid goiters (struma nodosa) - 55%, adenoma and thyroid goiters - 17%, thyroid cancer (ca papillare) and thyroid goiters - 11%, ectopic thyroid gland - 11%, thyroid goiters and thyroid inflammation - 6%. The majority of the material were cases of a cervico-mediastinal thyroid gland, only 2 patients were diagnosed with an ectopic thyroid gland located in the mediastinum with no connection with the cervical thyroid. The local symptoms of compression on intrathoracic organs were mostly observed in the clinical picture, 22% of patients were asymptomatic. The diagnostic process included the estimation of the hormonal state and the radiology localised methods among which helical computer tomography was the most valuable. In order to estimate endotracheal intubation conditions 11 patients (61%) underwent brochofiberoscopy. The following accesses were used in the treatment: cervical - 3 cases, partial sternotomy - 11, longitudinal sternotomy - 2, thoracotomy - 1, combined thoracotomy with cervicotomy - 1. Good treatment results were obtained in all cases. The following complications were noted: a permanent paralysis of the laryngeal nerve - 1 case (6%), hypoparathyroidism - 1 (6%).Conclusions. Thyroid goiters situated inside the chest are a rarely met pathology which may cause serious difficulties in surgical treatment. Patients with this illness require a thorough preparation for the treatment including balancing hormonal perturbations, preventing intubation difficulties and access to the necessary quality of a diagnostics wit purpose of planning the most optimal surgical access and avoiding serious perioperative complications.