Surgical Outcome of Retrosternal Goiter: A 5-year Retrospective Study

Abstract

Abstract Background Retrosternal goiter refers to any thyroid enlargement in which over 50% of the thyroid permanently located under the thoracic inlet or the lower pole of thyroid is not palpable with the neck in hyperextended position(1). Retrosternal goiter occurs in 2-26% of thyroidectomies, with a female preponderance and a familial component in up to 30% of cases. Surgery is the best treatment for retrosternal goiters due to thyroid growth and malignancy. Cervical incision is commonly used, but some cases require extracervical approach like sternotomy or thoracotomy(2). There are only case reports on retrosternal goiter in Ethiopia. Objective To Assess clinical presentation, options of surgical management and outcome of patients surgically treated for retrosternal goiters in SPHMMC from January 2017 to December 2022 GC. Methodology A retrospective review of patients’ medical records over a five-year period, Jan, 2017 to Dec, 2022, was carried out. OR log books, and individual patient medical record was used for review. Data was cleaned and analyzed using SPSS version 23 for windows. Means, standard deviations and percentages were calculated. Results: A total of 1621 patients had thyroidectomy in a five-year period. Of these, 60 were cases of retrosternal goiter making a prevalence of 3.7%. About 44(73.3%) of the patients were females whereas 16(26.7%) were males with F: M ratio of 2.8:1. The mean age at diagnosis was 52 with a range of 19-75 and duration of illness ranged from 7 months to 40 years with mean of 4.7 years. The most common mode of clinical presentations were cervical mass (93.3%), dyspnea (61.7%), dysphagia (16.7%), chest pain (8.3%), hoarseness of voice (5%) and SVC syndrome (1.7%). Functionally, 23 patients (38.3%) were hyperthyroid whereas 37 (61.7%) were euthyroid. FNAC test revealed that (3.3%) were malignant and (96.7%) were benign. Twenty-eight individuals had CT scan; 21(75%), 5(17.9%) and 2(7.1%) of the patients displayed Grade 1, Grade 2 and Grade 3 respectively according to CSI classification. Hence 45% of the cases were diagnosed intraoperative as cases of RSG. Thyroidectomy was achieved in 96.7% of the patients via cervicotomy and 3.3% had sternotomy. V Wound hematoma 13.3%, transient hypocalcaemia 10 %, loss of high pitched voice 5%, and pneumonia (1.7%) were the commonest complications. One patient (1.7%) who presented with SVC syndrome had an ICU admission for close monitoring and was discharged from ICU after 2 days. All patients were found to have post-operative follow-up and all had improvement. No postoperative mortality. Conclusion Retrosternal goiters may exist in absence of symptoms or signs. Majority of retrosternal goiter cases are benign. Hyperthyroidism make significant proportion of the patients. Nearly all the retrosternal goiter patients can be approached via cervicotomy. Morbidity and mortality rates are comparable to the literature. Key Words: Retrosternal goiter, Sternotomy, Cervicotomy