Delayed Presentation of Forgotten Thyroid Goiter - 25 Years After Thyroidectomy

Area of Science:

• Endocrinology
• Thoracic Surgery
• Surgical Oncology

Background:

• Forgotten goiter, a rare complication (2-16% of retrosternal thyroid cases), involves recurrence of retrosternal thyroid mass from overlooked remnant tissue after thyroidectomy.
• Retrosternal goiters can cause significant mass effect and localized pressure symptoms.

Observation:

• A 59-year-old female presented with dyspnea and stridor 25 years after total thyroidectomy.
• Radiographic imaging revealed a mediastinal mass consistent with recurrent retrosternal thyroid tissue.
• The mass exhibited extensive growth, adhering to vital thoracic structures.

Findings:

• The recurrent retrosternal thyroid mass was successfully excised using an extra-cervical approach and partial sternotomy.
• Complete excision of the thyroid tissue was achieved, despite its adherence to vital structures.
• The patient's presenting symptoms of dyspnea and stridor were fully resolved post-operatively.

Implications:

• This case highlights the possibility of late recurrence of retrosternal goiter even decades after thyroidectomy.
• An extra-cervical approach with partial sternotomy can be a viable surgical strategy for managing extensive retrosternal thyroid masses.
• Complete surgical excision is crucial for symptom resolution and preventing long-term recurrence.