Enlargement of Intrathoracic Goiter with Unilateral Phrenic Nerve Paralysis Leading to Cardiopulmonary Arrest

Non-Surgical Approaches to the Management of the Intrathoracic Goiter-A Systematic Review

BACKGROUND

Intrathoracic goiters (ITGs) are usually managed by surgical excision, However, over recent years, non-surgical strategies are emerging as an alternatives for treating this condition.

METHODS

A systematic review of research published since 2017 in the PubMed database was conducted and a total of 39 articles were retrieved, along with methodological issues and future directions in the research on ITGs.

RESULTS

Several non-surgical treatments exist, including radio-iodine ablation (RIA) and mini-invasive approaches, such as transcervical microwave ablation (TcMA), transcervical radiofrequency ablation (TcRfA), or selective embolization of the thyroid arteries (SETA). Despite encouraging reports, their current use remains limited.

CONCLUSIONS

Treatment of ITGs requires a multidisciplinary thyroid team, and when non-surgical options are chosen, patients need to be carefully selected, and their outcomes must be prudently considered and discussed with the patient.

Cardiopulmonary Arrest Caused by Large Substernal Goiter-Treatment with Combined Cervical Approach and Median Mini-Sternotomy: Report of a Case

INTRODUCTION

Substernal goiter is usually defined as a goiter that extends below the thoracic inlet or a goiter with more than 50% of its mass lying below the thoracic inlet. Substernal goiters may compress adjacent anatomical structures causing a variety of symptoms.

CASE REPORT

Here we report a rare case of a 75-year-old woman presenting with cardiac arrest caused by acute respiratory failure due to tracheal compression by a substernal goiter.

DISCUSSION

Substernal goiters can be classified as primary or secondary depending on their site of origin. Symptoms are diverse and include a palpable neck mass, mild dyspnea to asphyxia, dysphagia, dysphonia, and superior vena cava syndrome. Diagnosis of substernal goiter is largely based on computed tomography imaging, which will show the location of the goiter and its extension in the thoracic cavity. Surgery is the treatment of choice for symptomatic patients with substernal goiter. The majority of substernal goiters are resected through a cervical approach. However, in approximately 5% of patients, a thoracic approach is required. The most important factor determining whether a thoracic approach should be used is the depth of the extension to the tracheal bifurcation on CT imaging.

CONCLUSION

Cardiac arrest appearing as the first symptom of a substernal goiter is a very rare condition and should be treated by emergency thyroidectomy via a cervical or thoracic approach depending on the CT imaging findings.