Intrathoracic goitre. Surgical treatment in an ENT department

Eighteen consecutive cases of intrathoracic goitres operated in an ENT department during a four-year period from 1977-1981 are presented. Massive intrathoracic extension, with at least half of the gland located below the top of the sternum, was seen in all cases. Seventy-eight per cent of the patients had respiratory symptoms, which, in most cases, was so extreme that periodic or manifest stridor was present. The gland could be extirpated through a wide Kocher's incision in all cases. There was no mortality, only a single case of hypoparathyroidism and no recurrent nerve paresis or other complications. Traditionally operation of intrathoracic goitre is performed in thoracic surgical departments. Sternal splitting or lateral thoracotomy, however, is only necessary in a very few cases. It is concluded that surgical treatment of patients with large intrathoracic extension can be performed with advantage in ENT departments by surgeons experienced in head and neck cancer surgery using the operating microscope to lessen risk of damage to the recurrent laryngeal nerves.