Retrosternal (intrathoracic) goitre--diagnosis and surgical treatment

For a period of 12 years (1987-1998) 2033 patients underwent surgical treatment of the thyroids in the surgical clinics of the Higher Medical Institute in Plovdiv. Retrosternal or intrathoracic goitre was found in 29 patients (p +/- Sp = 1.43 +/- 0.26%). Of these, seven were males and 22 females all aged 32 to 76 years. Twenty two of the patients were euthyroid and seven hyperthyroid (75.9 +/- 7.9% and 24.1 +/- 7.8%, respectively). Compression of adjacent organs was detected in 19 of the patients (65.5 +/- 8.8%) (P < 0.05). X-ray, ultrasonography, scintigraphy (gamma-chamber), computed tomography, and in cases of voice disorders, direct laryngoscopy were used in making the diagnosis. All patients underwent surgical treatment. Cervical collar incision was suitable in 27 patients and in one patient longitudinal sternotomy was used and in other, who had deep posterior mediastinal goitre, Hart's method of combined thoracotomy and cervicotomy was required. The weight of the resected glands varied from 50 to 1500 g. The results obtained are discussed in terms of the incidence, type, and site of the retrosternal (intrathoracic) goitre, capabilities of the contemporary methods of diagnostics, surgical necessities, surgical approach and compared with literature data.