RETRO-STERNAL GOITRE

Very few retrosternal goitre arise from ectopic thyroid tissue, most arise from lower pole of nodular goitre. If neck is short and pretracheal muscles are strong especially in men the negative intrathoracic pressure tends to draw these nodules into superior mediastinum

Clinical Features

·         Dyspnoea, particularly at night,cough, stridor

·         Dysphagia

·         Engorgement of facial, neck,superficial chest wall veins: occurs in cases of obstruction of superior venacava

·         Recurrent nerve paralysis; the goiter may be also malignant or toxic

Diagnosis

·         Chest and thoracic inlet Radio graphs

·         CT scan, MRI

·         Flow-volume pulmonary function test; to detect degree of obstruction

Treatment

No role for anti-thyroid drugs and radio-iodine,resection is carried out from neck sometimes median sternotomy is needed. Fragmentation during resection must be avoided in case of malignancy. Recurrent laryngeal N injury is common.

                                                                                                                   

   Ref: BAILEY AND LOVE