The "forgotten" goiter after total thyroidectomy

Area of Science:

• Endocrinology
• Surgical Oncology
• Radiology

Background:

• Forgotten goiter is a rare condition defined as a mediastinal thyroid mass discovered after total thyroidectomy.
• It often results from incomplete removal of a plunging goiter or an unrecognized mediastinal goiter.
• Preoperative imaging like chest X-rays may not always detect substernal goiters.

Purpose of the Study:

• To present two cases of forgotten goiter.
• To highlight diagnostic challenges and management strategies for this rare condition.

Main Methods:

• Case report of two patients diagnosed with forgotten goiter after total thyroidectomy.
• Diagnostic workup included thyroid scintigraphy and CT scans.
• Surgical management involved median sternotomy and mass excision.

Main Results:

• Both patients successfully underwent surgical excision of the mediastinal thyroid mass without complications.
• One patient had papillary thyroid cancer, the other Graves' disease.
• Postoperative TSH levels and clinical presentation aided in diagnosis.

Conclusions:

• Forgotten goiter should be suspected when lower thyroid poles are not palpable or postoperative TSH levels are unchanged.
• Prompt surgical intervention can lead to favorable outcomes.
• Multimodality imaging is crucial for diagnosis.