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. 2017 Jul-Sep;13(3):261-265.
doi: 10.4183/aeb.2017.261.

RETROSTERNAL GOITRES: A PRACTICAL CLASSIFICATION

I T Cvasciuc  1 , S Fraser  1 , M Lansdown  2
Affiliations

RETROSTERNAL GOITRES: A PRACTICAL CLASSIFICATION

I T Cvasciuc et al. Acta Endocrinol (Buchar). 2017 Jul-Sep.

Abstract

Background: There is no standard definition for goitres extending below the thoracic inlet and no clear guidelines for pre-operative planning of surgery. The aim of this study is a practical classification of retrosternal goitres (RSG) based on the anatomical , radiological shape and size of the thyroid.

Methods: Retrospective analysis of all thyroidectomies performed in a referral centre between January 2012 and December 2016. Patients with RSGs had a pre-operative CT scan of neck/thorax. Imaging was reviewed to establish features to predict the difficulty of delivering the goitre through the neck incision and to advise the best surgical approach.

Results: 847 thyroidectomies were performed with n=98 involving RSGs. TypeA (n=47) are RSG with a shape of a "cone" or pyramid with the apex pointing down. Cervicotomy is the usual approach. TypeB (n=39) are goitres with a shape of a "pyramid' with the apex pointing up, cervicotomy with ± manubriotomy or sternotomy ± thoracotomy maybe required. TypeC (n=6) are thyroid enlargements in the mediastinum connected by a pedicle with the thyroid in the neck. A cervical approach ± manubriotomy or sternotomy ± thoracotomy is needed. TypeD (n=6) are true intrathoracic or "forgotten" goitres. Sternotomy is indicated for thyroids in the anterior mediastinum though a thoracic approach for those located in the posterior mediastinum might be needed.

Conclusion: The shape and size of goitres is important in carefully planning surgery. CT imaging with cross-sectional reconstruction should be analysed before operation. The proposed classification helps treatment planning and allows comparison of outcomes by anatomical complexity.

Keywords: classification; retrosternal goitre; surgical approach.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1.
Figure 1.
Type A cervicothoracic goitre (pyramidal with its apex pointing down).
Figure 2.
Figure 2.
Type B cervicothoracic goitre (pyramidal with its apex pointing up).
Figure 3.
Figure 3.
Type C cervicothoracic goitre (bilobal goitre with a narrow neck or pedicle).
Figure 4.
Figure 4.
Type D cervicothoracic goitre (ectopic goitre, primary intrathoracic, no previous surgery, located in anterior compartment of mediastinum).
Figure 5.
Figure 5.
Type D cervicothoracic goitre (recurrent goitre ‘forgotten goitre’, located in the anterior compartment of mediastinum).
See this image and copyright information in PMC

References

    1. Klein F, Veber K. Die Austrotting verschiedener geschwulste, besonders jener der Ohrspercheldruse und der Schiddruse; Aussachalung der Schilddruse. J Chir Augenlleilk. 1820;12:106–113.
    1. Porterfield JR, Factor DA, Grant CS. Technique of total thyroidectomy for large substernal goiters. Operative Techniques in Otolaryngology - Head and Neck Surgery. 2009;20(1):18–22.
    1. Hegedus L, Bonnema SJ. Approach to management of the patient with primary or secondary intrathoracic goiter. J Clin Endocrinol Metab. 2010;95(12):5155–5162. - PubMed
    1. Porzio S, Marocco M, Oddi A, Lombardi V, Porzio O, Calvelli C, Scotti A, Listorti N, Porzio R. Endothoracic goitre: anatomoclinical and therapeutic considerations. Chir Ital. 2001;53(4):453–460. - PubMed
    1. Mercante G, Gabrielli E, Pedroni C, Formisano D, Bertolini L, Nicoli F, Valcavi R, Barbieri V. CT cross-sectional imaging classification system for substernal goiter based on risk factors for an extracervical surgical approach. Head Neck. 2011;33(6):792–799. - PubMed

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