Surgery for Retrosternal Thyroid Tumor

Retrosternal goitre is defined as enlargement of thyroid gland with a major portion of its mass located in the upper chest. Surgical removal is the treatment of choice and, in most cases, it can be done by a cervical approach.

We present a case of a 56-year-old lady who presented with a large swelling in the front of neck for last one year. There was progressive increase in size with pain and difficulty in breathing. On examination there was a large multinodular thyroid enlargement. CT Scan of neck showed extension of the mass in to the upper chest. There was also evidence of mild compression of trachea and deviation to one side. Patient underwent successful removal of the entire thyroid gland along with the mass (Total Thyroidectomy) from neck incision. Postoperative recovery was good and patient was discharged within three days from the hospital.

Surgical removal of retrosternal thyroid enlargements are challenging procedures; it can be performed safely, in most cases, via a cervical approach. A very selected group of patients may require a chest incision (sternal thoracotomy) to remove the lower part only if the tumor is very large or there is involvement of great vessels of the heart or the trachea (wind pipe). If retrosternal goitre thyroidectomy is performed by a skilled surgical team, familiar with its unique pitfalls, the assistance of a thoracic surgeon may be required only in a few selected cases.