A Comprehensive Study of Mediastinal Goiters

Background: Thyroid masses are common, especially in areas of iodine deficiency. Mediastinal goiter is defined by the presence of enlarged thyroid tissue below the level of the thoracic inlet. This study aimed to evaluate the presentation, diagnosis, treatment, histopathological findings and complications of patients with mediastinal goiter or masses. Materials and Methods: This was a descriptive cross-sectional chart review study of patients with substernal goiter or masses who underwent cervical and mediastinal thyroidectomy from March 2003 to February 2007. Results: From a total of 470 patients admitted for thyroid surgery, 60 cases (12.7%) presented with substernal extension of goiter or masses during the study period; 88% of patients were females with a mean age of 46.77±10.77 yrs. Cervicalmasses were the most common preoperative presentation (78%), followed by compressive symptoms (67.8%); 5.08% of cases were asymptomatic. In 10%, the goiter or masses were located in the posterior mediastinum. Total thyroidectomy was performed in 59% of patients mostly by low collar incision. Sternotomy or thoracotomy was required in three patients (5%)mainly because of mediastinal masses or invasion of carcinoma. Postoperative complications included transient hypocalcaemia (46%) and persistent recurrent nerve paralysis (3.4%). There was no mortality. Histopathologically, 18.5% of masses were malignant; mostly papillary carcinoma.Conclusion: Presence of substernal goiter or masses is an indication for early surgery, even in asymptomatic or elderly patients. These masses have progressive enlargements and carry a high risk of tracheal compression.