Primary intrathoracic goiter: a rare and potentially serious entity

Area of Science:

• Thoracic surgery
• Congenital anomalies
• Endocrinology

Background:

• Primary intrathoracic goiter (P-ITG) is a rare congenital condition, distinct from secondary goiters extending from the cervical thyroid.
• P-ITGs lack cervical thyroid connection and receive blood supply from intrathoracic vessels.

Observation:

• P-ITGs are primarily located in the anterosuperior mediastinum, with 15% in posterior or middle locations, complicating diagnosis.
• These goiters can coexist with normal or abnormal cervical thyroid glands, potentially experiencing independent pathological processes.
• Large P-ITGs can cause significant mediastinal organ compression, most commonly affecting the trachea.

Findings:

• Computerized axial tomography (CT) and radionuclide imaging aid in diagnosing P-ITGs.
• Differential diagnosis includes mediastinal tumors with high unenhanced CT attenuation.
• Progressive growth is characteristic, necessitating timely surgical intervention.

Implications:

• Surgical resection via a thoracic approach is the definitive treatment for P-ITGs.
• Early surgical intervention prevents serious complications such as tracheomalacia, especially in cases of long-standing tracheal compression.
• Thoracic surgery for small P-ITGs is generally safe, but long-standing goiters can complicate the procedure due to induced tracheomalacia.