Abstract
Aim. A residual mediastinal thyroid (“forgotten goiter”) is a well-known, though uncommon, complication of total thyroidectomy. Materials of study. The authors analyze their experience with three cases of goiter forgotten, observed in a series of 2946 thyroid resections in the period 2005–2010. In the study, a preoperative CT of the chest with three-dimensional reconstruction was always performed to examine the topographical relationships of the lesion. Excision was performed through cervicotomy, cervicosternotomic approach and cervicosternotomy, and posterolateral right thoracotomy. Results. There were no complications. Histological examination was suggestive of malignancy in one case (follicular carcinoma with pulmonary metastases). Discussion. The indication for surgery in cases of forgotten goiter is intrinsic to the diagnosis. Preoperative evaluation with accurate topographic imaging is required in all cases in order to understand the nature and location of mediastinal pathological tissue and to identify the most suitable access route. The cervicotomy is the ideal access for low surgical trauma and is easily extendable into a partial or complete sternotomy. A thoracotomy, on the other hand, which is usually reserved for the right side, must be planned preoperatively.
Similar content being viewed by others
References
Reeve T.S., Rundel F.F., Hales H.B. et al., The investigation and management of intrathoracic goiter, Surg Gynecol Obstet, 1962, 115, 223–229
Rother H.D., Goretzk P.E., Wahl R.A., Frilling A., Intrathorakale stuma, Chirurg, 1989, 60, 384–390
Massard G., Wihlm J.M., Jeung M.Y., Roeslin N., Dumont P., Witz J.P., Morand G., Le goitre mediastinal oubliè: sept observation, Ann Chir, Chir thorac cardio-vasc 1992, 46(8), 770–773.
Avenia N., Sanguinetti A., Cirocchi R., Docimo G., Ragusa M., Ruggiero R., Procaccini E., Boselli C., D’Ajello F., Barberini F., Parmeggiani D., Rosato L., Sciannameo F., De Toma G., Noya G., Antibiotic pophylaxis in thyroid surgery: a preliminary multicentric italian experience, Ann of Surg Innovation and Research, 2009, 10.1186/1750-1164-3-10
D’Andrea V., Cantisani V., Catania A., Di Matteo F.M., Sorrenti S., Greco R., Kyriakos K., Menichini G., Marotta E., De Stefano M., Palermo S., Di Marco C., De Antoni E., Thyroid tissue remnants after “total thyroidectomy”, G Chir, 2009, 30(8–9), 339–344
Cirocchi R, Boselli C, Guarino S, Sanguinetti A, Trastulli S, Desiderio J, Santoro A, Rondelli F, Conzo G, Parmeggiani D, Noya G, De Toma G, Avenia N. Total thyroidectomy with ultrasonic dissector for cancer: multicentric experience. World J Surg Oncol. 2012Apr 27;10:70. doi: 10.1186/1477-7819-10-70.
Cirocchi R, D’Ajello F, Trastulli S, Santoro A, Di Rocco G, Vendettuoli D, Rondelli F, Giannotti D, Sanguinetti A, Minelli L, Redler A, Basoli A, Avenia N. Meta-analysis of thyroidectomy with ultrasonic dissector versus conventional clamp and tie. World J Surg Oncol. 2010Dec 23;8:112. doi: 10.1186/1477-7819-8-112.
Fattovich G., Franceschini F., D’Atri C., Il gozzo “mediastinico” dimenticato, Chir Triveneta, 1994,34(1), 10–14
Riquet M., Deneuville M., Debesse B., Chretien I., Goitre endothoracique autonome. A propos de deux noveau cas, Rev Pneumol Clin, 1986,42,267–273
Hall T.S., Caslowitz P., Popper C., Smith G.W., Susternal goither versus intrathoracic aberrant thyroid: a critical difference, Ann Thorac Surg, 1988, 46, 684–685
Grigoletto R., Toniato A., Piotto A., Bernante P., Bernardi C., Pagetta C., Pelizzo M.R., Su di un caso di gozzo oublié gigante, Minerva Chir,1997, 52, 943–948
Marrano D., Taffurelli M., Casadei R., Il gozzo retro sternale, Da Rosato l: La patologia chirurgica della tiroide e delle paratiroidi. Protocollo di trattamento diagnostico e terapeutico, Santhià (VC), Club delle UEC, 2000, 140–147
Buckley J.A., Stark P., Intrathoracic mediastinal thyroid goither: imaging manifestation, AJR, 1999, 173, 471–475
Cirocchi R, Trastulli S, Sanguinetti A, Cattorini L, Covarelli P, Giannotti D, Di Rocco G, Rondelli F, Barberini F, Boselli C, Santoro A, Gullà N, Redler A, Avenia N. Recurrent differentiated thyroid cancer: to cut or burn. World J Surg Oncol. 2011 Aug 12;9:89. doi: 10.1186/1477-7819-9-89.
Casadei R., Perenze B., Calculli L., Minni F., Conti A., Marrano D., Gozzo “dimenticato”: caso clinico e revisione della letteratura, Chir Ital, 2002, 54(6), 855–860
Vadasz P., Kotsis L., Surgical aspects of 175 mediastinal goiters, Eur J Cardiothorac Surg, 1999, 86, 1235–1236.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Avenia, N., Santoprete, S., Monacelli, M. et al. The forgotten goiter: casuistic contribution and considerations for the choice of surgical approach. cent.eur.j.med 8, 415–419 (2013). https://doi.org/10.2478/s11536-013-0183-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.2478/s11536-013-0183-4