Thursday, November 14, 2013

What is Retrosternal Goiter?


Goiter
Source: www.commons.wikimedia.org
Introduction
First of all we are to know that what is goiter. Enlarged (swollen) thyroid gland is known as goiter. And, now we are to dig-out that what are the meanings of retrosternal goiter. When more than 50% of enlarged thyroid tissue is found below suprasternal notch behind the sternum, it is called retrosternal goiter. It might be primary or secondary retrosternal goiter. Primary goiter arises from the ectopic thyroid tissue present in mediastinum while secondary retrosternal goiter is just the extension of the enlarged thyroid from the neck. The patient may show hyperthyroidism or hypothyroidsim symptoms. 

Types

There are three types of retrosternal goiter, substernal type, plunging type and intrathoracic goiter. Substernal type of retrosternal goiter can be felt as a palpable nodule in the lower neck. Sometimes intrathoracic goiter is pushed onto the neck due to the increased intrathoracic pressure. While in intathoracic goiter, all the thyroid tissues are present in the thorax and the neck looks normal. Diagnosis can be made clinically by noticing the clinical features or signs and symptoms of goiter.

Signs and Symptoms

Retrostrnal goiter can be easily assessed by the clinical features. Clinical features of retrosternal goiter include:
(1) Dyspnoea: When the patient is lying at night or when the neck is extended.

(2) Engorgement of neck veins: Neck veins are engorged in case of retrosternal goiter due to increased pressure in the thorax due enlarged thyroid.

(3) Cough and strider

(4) Hoarsness of voice

(5) Dysphagia due to enlarged thyroid

(6) Dull percussion note over manubrium sterni

(7) Retrosternal goiter can be nodular, toxic or malignant.

(8) Recurrent nerve palsy may occur but rare.

(9) Pemberton’s sign: When the patient is asked to raise his/her arms above the shoulder, the retrosternal goiter compresses the structures (e.g. superior vena cava and trachea) and causes the neck veins to dilate which can be inspected over the neck.

(10) Soft tissue shadow is seen in the mediastinum on chest x-ray.

(11) Radioactive iodine study and CT scan are useful.

The most threatening symptom of retrosternal goiter is dysponea as it leads to death immediately.

Treatment 

Retrosternal goiter treatment is surgical removal. During goiter surgery, first off, ligation and division of superior thyroid vessels, division of middle thyroid veins and inferior thyroid artery is done. Then cervical part of goiter is mobilized and removed by traction and finger mobilization. If retrosternal goiter is large enough then goiter can be broken into pieces with fingers and delivered piecemeal. In all this procedure, special attention is considered for recurrent laryngeal nerve.


Keywords: Retrosternal goiter, hypothyroidsim symptoms, Goiter symptoms, Goiter treatment, Goiter surgery

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