[Intrathoracic goiter]

A goiter, situated partly or on completely in the thoracic cavity is usually referred to as intrathoracic goiter (ITG). However, inadequate definition of intrathoracic malpositions of thyroid gland caused usage of different classifications. This produced different and, often unclear criteria for the grouping of intrathoracic thyroid malpositions and, consequently, very different results and difficulties in any attempt of parallel review or analysis. The aim of this research was to analyze the ITG that include goiters with more than 80% of tissue in the thoracic cavity and intrathoracic thyroid choristomas, and to point out the diagnostic problems and surgical dilemmas.

Source of the used data were the studies published in the last 50 years in English, French, Italian, German and Russian language. Data have been integrated and combined for the detailed analysis, while quantitative synthesis was achieved by statistical analysis.

ITG was represented in 1% of operatively treated thyroid diseases. One third of patients were asymptomatic. Commonly observed symptoms were dyspnea, stridor and dysphagia, and there was no significant difference in appearance of these symptoms between the two groups of ITG. Chest roentgenography and CT scan could provide the maximal information with no need for expensive procedures. Accuracy of scintigraphy in revealing and discerning of ITG is 70%, averagely. In 20% of patients correct preoperative diagnosis was not established. Therapy of choice in the treatment of ITG was surgical, even in asymptomatic cases. Thoracic approach was used in 95% of cases and there was no significant difference between the two groups of ITG. Total thyroidectomy or total lobectomy was definitely obligatory with contralateral subtotal lobectomy. There was no significant difference in the frequency of operative complications between ITG and non-ITG, and between the two groups of ITG.

ITG is rare, but might present a difficult diagnostic and complex surgical problem. Common clinical presentation and identical surgical approach in operative treatment justify the common review of the two groups of ITG. With timely and adequately performed surgical approach, in specialized institutions, frequency of complications in operative treatment of ITG was not higher if compared to operative treatment of non-ITG.