Bocio endotorácico remanente a seis años de postiroidectomía total / Unusual endothoracic goiter after six year of total post-thyroidectomy

El bocio endotorácico remanente se define como el hallazgo de tejido tiroideo mediastinal después de una tiroidectomía total. Es una entidad infrecuente y generalmente el tumor se encuentra en el mediastino anterior, en posición retroesternal. Se presenta el caso de un paciente con bocio endotorácico remanente postiroidectomía total diagnosticado 6 años después. Se le realizó una exéresis a la enferma de la lesión sin complicaciones intra ni posoperatorias(AU)

Unusual endothoracic goiter is defined as the finding of mediastinal thyroid tissue after total thyroidectomy. It is uncommon and generally the tumor is located in the anterior mediastinum at retrosternal position. This was a patient with unusual endothoracic goiter after total thyroidectomy and diagnosed six years later. The lesion was excised with no intraoperative or postoperative complications(AU)

Les goitres plongeants : particularites cliniques; radiologiques et therapeutiques

Introduction: Les goitres plongeants; devenus rares de nos jours; posent des problemes diagnostiques et chirurgicaux particuliers. Leur prise en charge est facilitee par l'apport de la tomodensitometrie permettant de planifier l'attitude therapeutique.Le but de ce travail est de preciser les modalites d'exploration et de prise en charge chirurgicale des goitres plongeants. Materiels et methodes : Nous rapportons une etude retrospective portant sur42 cas de goitre plongeant colliges sur une periode de 11 ans entre 2001 et 2011. Resultats : L'age moyen de nos patients etait de 56;9 ans (36-86 ans). Le sex-ratio etait de 0;13. La tumefaction basi-cervicale etait le motif de consultation le plus frequent; rapportee dans 74 des cas associee a des signes de compression oesotracheale dans 45 des cas.Une paralysie recurrentielle unilaterale a ete objectivee dans 3 cas.Une radiographie de thorax a montre un elargissement mediastinal dans 23 des cas avec deviation tracheale chez 63 des malades. Une TDM cervico-thoracique pratiquee dans 85 des cas a confirme le diagnostic. Le traitement chirurgical etait mene par voie cervicale exclusive chez tous les patients. Une paralysie recurentielle a ete observee dans 3 cas. Aucune hypoparathyroidie definitive n'a ete rapportee avec un reculmoyen de 24mois. Conclusion : Les goitres plongeants devenus rares du fait de la prise en charge plus precoce des nodules thyroidiens. Ils posent actuellement moins de difficultes therapeutiques. L'indication chirurgicale est toujours formelle devant le risque vital qu'ils posent

Bocio endotorácico / Endothoracic goiter

Se informa el caso de una paciente de 71 años de edad, con antecedentes de hipertensión arterial, que acude a consulta externa pues hace unos 5 años presenta aumento de volumen de la región inferior y lateral del cuello que se acompaña de decaimientos, palpitaciones y disfagia ocasional. Se realizaron los estudios de laboratorio para la valoración preoperatoria, además de los estudios de la función tiroidea, radiografías de tórax (vista anteroposterior), tomografía de tórax, ecografía de la tiroides y biopsia de aspiración con aguja fina. Se encontró un bocio endotorácico eutiroideo y se realizó tratamiento quirúrgico que consistió en hemitiroidectomía izquierda con istmectomía. El transoperatorio y el posoperatorio transcurrieron sin complicaciones, y el informe anatomopatológico reveló la presencia de un bocio coloide nodular(AU)

This is the case of a female patient aged 71 with a history of high blood pressure seen in external consultation since five years ago she presents a volume increase of lower and lateral region of the neck accompanied of weakness, palpitations and occasional dysphagia. Laboratory studies were conducted to preoperative assessment in addition to thyroid function studies, thorax X-rays (anteroposterior view), thorax tomography, thyroid gland echography and fine needle aspiration biopsy (FNAB). A euthyroid endothoracic goiter was present; surgical treatment was done consisting of left hemithyroidectomy with isthmectomy. In transoperative and postoperative periods there were not complications and the anatomic and pathologic report revealed the presence of nodular colloid goiter(AU)

experience with retrosternal Goiter: analysis of 89 cases

To determine the frequency of retrosternal goiter, clinical presentation and post operative complications among the patients presenting with goiter. It is a prospective, crossectional study conducted at Department of Surgery, Fauji Foundation Hospital, Rawalpindi from January 1997 to December 2008. All patients with goiter were evaluated for retrosternal extension of thyroid, clinical presentation, and post operative complications. Among 978 patients, 89 [9.10%] patients had retrosternal extension of thyroid. Majority of the patients were female [94.51%] and euthyroid [91.02%]. Among all the patients, [39.33%] were in the 5th decade. Retrosternal extension of both lobes was found in 83.15% and one lobe in 16.15% patients. Dysponea was the commonest complaint by all patients, followed by headache [30.33%] and dysphagia [25.84%]. Recurrent laryngeal nerve palsy was seen in 4.49% patients and 3.37% patients developed hypocalcaemia and wound infection after surgery. Retrosternal extension of thyroid is not uncommon. Surgery can be easily done through cervical approach

Avaliação crítica de 33 pacientes com bócio mergulhante tratados cirurgicamente por cervicotomia / A critical analysis of 33 patients with substernal goiter surgically treated by neck incision

A possibilidade de ser necessário um acesso combinado, com uma incisão cervical e outra torácica, torna o tratamento do bócio mergulhante um desafio tanto no pré quanto no intra-operatório. Discutimos uma padronização da técnica cirúrgica para minimizar a necessidade da abordagem torácica, tornando o bócio mergulhante uma patologia tratável cirurgicamente, por uma única incisão cervical, e com baixos índices de complicações. OBJETIVO: Avaliar a abordagem cirúrgica do bócio mergulhante por cervicotomia e analisar as complicações cirúrgicas. MATERIAL E MÉTODOS: Foi realizada uma coorte histórica com corte transversal por análise retrospectiva dos prontuários de pacientes submetidos à tireoidectomia no período de maio de 2002 a julho de 2007. Um total de 316 pacientes foi submetido à tireoidectomia sendo 33 (10,4 por cento) por bócio mergulhante. RESULTADOS: Todos os 33 pacientes foram tratados cirurgicamente por via cervical sem necessidade de esternotomia. Não foram observadas lesões definitivas de nervo laríngeo inferior ou hipoparatireoidismo definitivo. Apenas 2 pacientes apresentaram paresia de nervo recorrente e 2 pacientes foram reabordados por hematoma cervical. CONCLUSÃO: Pacientes com bócio mergulhante podem ser tratados cirurgicamente por uma única incisão cervical com segurança e baixos índices de complicação.

The possibility of needing a combined access, with neck and chest incisions makes the treatment of substernal goiter a challenge both in the pre-op and the intraoperative. We hereby, discuss a standardization of the surgical technique to minimize the need for a chest approach, making the substernal goiter a surgically treatable disease, through a single neck incision, and with low indices of complication. AIM: to assess the substernal goiter surgically approach through a neck incision and to analyze the surgical complications. MATERIALS AND METHODS: we carried out a historical cohort by retrospective analysis of the charts of patients submitted to thyroidectomy, and 33 of them (10.4 percent) had substernal goiter. RESULTS: all 33 patients were surgically treated through a neck incision without the need for sternotomy. We did not observe definitive lesions in the inferior laryngeal nerve or definitive hypoparathyroidism. Only 2 patients had recurrent nerve paresis; and 2 patients were re-operated because of a neck hematoma. CONCLUSION: patients with substernal goiter can be safely treated surgically through a single neck incision, bearing low complication rates.

Bócio ectópico intratorácico primário no mediastino posterior: relato de caso e revisão de literatura / Primary ectopic intrathoracic goiter in posterior mediastinum: a case report and review of the literature

O bócio ectópico intratorácico primário é entidade muito rara que corresponde à presença de tecido tireoidiano aberrante hiperplasiado, localizado no interior do tórax, sem possuir nenhum contatoou relação com a tireóide cervical, que se encontra geralmente com aspecto normal. Apresentamos um caso de paciente do sexo feminino, 61 anos de idade, com os achados de radiografia etomografia computadorizada, associado a revisão de literatura, demonstrando os achados de imagem, diagnósticos diferenciais, possíveis fatores etiológicos e os tratamentos.

The ectopic primary intrathoracic goiter is an uncommon tumor that corresponds to a hyperplasia of an ectopic thyroid tissue, that develops in the thorax, distinct from the cervical thyroid gland,which usually exists on its normal aspect. We report the case of a 61-year-old female patient, with the aspects of the radiograph and computed tomography examinations, comparing them with the literature, demonstrating the image aspects, differential diagnosis,possible etiology factors and treatments of the disease.

Retrosternal goitre: analysis of 48 patients

Retrosternal goiter is defined as any goiter in which at least 50% of the thyroid resides below the level of the thoracic inlet, and it is a common cause of compression of adjacent structures. To highlight the epidemiology, clinical features and surgical complications of retrosternal goiter. All patients operated for thyroid disease in period from June 1996 to Dec 2003 in the surgical department of 7[th] October Hospital were retrospectively analyzed age, gender and clinical features were noted. Out of 1898 thyroidectomies performed, 48 patient were found to have retosternal goiter [2.5%] The mean age was 42 yrs [25-77 yrs]. 41 [85.5%] were females and 7 [14.5%] patients were males. A 43 [89.6%] patients were euthyroid, 4 [8.3%] patients were toxic and 1 [2.1%] patient hypothyroid. About one fourth of the patients were asymptomatic. Commonly observed symptoms were, shortness of breath, hoarseness, dysphagia and superior vena cava obstruction. In all patient the goiter was resected through cervical incision, except one patient who needed partial sternotomy. Near total thyroidectomy was performed in 29 [60%] cases. There were three complications and no death. The incidence of retrosternal goiter with respect to thyroidectomy patients is [2.5%]. Cervical incision is nearly always adequate. Retrosternal goiter dosen't seem to be associated with increased incidence of postoperative complications

Bócio de tireóide intratorácico e timoma invasivo: apresentação simultânea incomum / Intrathoracic goiter and invasive thymoma: rare concomitant presentation

Apresentamos uma rara situação de ocorrência simultânea de dois tumores de mediastino com diferentes topografias e histologias, encontrados durante a ressecção de volumosa massa mediastinal em paciente assintomático. A possibilidade de diferentes tumores contidos numa mesma massa tumoral está relatada; entretanto, não encontramos na literatura médica relato de diferentes tumores em localizações distintas. Os bócios de tiróide intratorácicos e os timomas representam uma grande parcela dos tumores encontrados no mediastino. O tratamento cirúrgico, sempre que possível, desempenha papel fundamental na perspectiva de cura. A exploração cirúrgica minuciosa é fundamental para uma ressecção completa e possível achado de lesões concomitantes.

We present a rare situation in which two mediastinal tumors of different topology and histology were found during the resection of an extensive mediastinal tumor in an asymptomatic patient. Different histologies within the same mass have been reported, although, to our knowledge, there have been no reports of different tumors at distinct locations. Thymomas and intrathoracic goiters account for a large proportion of the tumors found in the mediastinum. When feasible, surgical resection plays a fundamental role in effecting a cure. In order to identify concomitant lesions and perform a complete resection, detailed surgical exploration is required.

Manejo diagnóstico e terapêutico do bócio mergulhante / Diagnostic and therapeutic management of substernal goiter

As condutas clínicas e cirúrgicas no bócio mergulhante ainda são controversas, não havendo um consenso na literatura sobre qual o momento ideal para intervir cirurgicamente nos pacientes com esta enfermidade. É preciso conhecer as indicações, conseqüências e complicações do tratamento cirúrgico do bócio mergulhante. Este trabalho resulta de uma revisão de publicações sobre tratamento do bócio mergulhante no período de 1995 a 2000. As bases de dados utilizadas foram Medline e Lillacs. Objetiva-se atualizar, orientar e esclarecer dúvidas dos profissionais a respeito desses fatores. Discutem-se os métodos diagnósticos e as condutas terapêuticas em casos de bócio mergulhante...

There is no unanimity regarding clinical or surgical procedures in treatment of substernal goiter. Indications, consequences, and complications of substernal goiter surgery must be carefully evaluated. A review of the literaturc based on Medline and Lillacs regarding surgery of substernal goiter from 1995 to 2000 is made and discussed.

Les goitres plongeants A propos de 230 observations

We report a retrospective study of 23 intrathoracic goiters cases. It is question of 17 mediastinocervical cases and 6 cervico-mediastinal cases. No case of pure endothoracic goiter has been found to be present. There is a clear female prevalence [77% of cases]. In more than the half cases, the patients have a goiter history for more than 10 years. As for the compression signs, the tracheal compression is prevalent since that it was seen in 2/3 of cases. All patients underwent a successful cervictomy, carried out alone. No malignant intrathoracic goiter was seen in our series. The post - operative sequelae are most often simple in patients managed at time and the best conditions

Tumores y quistes del mediastino / Mediastinum tumors and cysts

Los tumores y quistes del medistino son lesiones poco frecuentes, que se originan en las estructuras propias de cada uno de sus compartimientos o en elementos extramediastínicos que lo invaden. El logro de buenos resultados terapéuticos en este tipo de patología requiere de un diagnóstico preciso y oportuno lo cual no siempre es fácil. En este artículo se revisan algunos aspectos de estas lesiones, destacando sus relaciones anatómicas, presentación clínica y estudio de laboratorio. Se describen los tumores más frecuentes y sus respectivas características clínicas, los exámenes complementarios de mayor rendimiento y modalidades terapéuticas actualmente en uso

Bocio cervicotorácico: experiencias y consideraciones sobre 57 casos / Cervicothoracic goiter: considerations and experiences of 57 cases

Se considera la experiencia sobre 57 casos de bocio cervicotorácico. Analizamos las clasificaciones de esta patología y se adopta la que consideramos más apropiada; se realiza el estudio clínico y métodos complementarios, destacándose la importancia de la T.A.C., como elemento de diagnóstico y orientador de la táctica quirúrgica a seguir. Damos las pautas de la técnica quirúrgica empleada; se analizan las complicaciones encontradas y advertimos de los riesgos de esta cirugía. Hacemos notar que con una cervicotomía amplia, prolija disección, individualizados los elementos nobles que se nos presentan, llegamos por esta vía a un final satisfactorio, en la casi totalidad de los casos. Destacamos las escasas complicaciones surgidas como consecuencia de un acto realizado con minuciosidad

Bócio mergulhante: estudo retrospectivo de 149 casos operados / Intra-thoracic goiter: retrospective study of 149 cases

Apresentam-se dados clínicos (história, sintomas e sinais, principalmente obstrutivos, das vias aéreas superiores) de 149 casos de bócio cervicotorácico operados (4.431 tiroidectomias) na Seçäo de Cirurgia Endócrina do Hospital do Servidor Público Estadual de Säo Paulo e Hospital Santa Catarina, Säo Paulo. Os exames complementares, como radiografia simples, contrastada, angiografia e mapeamento com I, säo analisados pré-operatoriamente e comparados aos pós-operatórios. Säo descritos cuidados técnicos e táticos para extrair a porçäo mergulhada do bócio através da abertura superior torácica, o que se conseguiu em 90% dos casos. Chama-se a atençäo para a ausência de tiroidite crônica nos exames anatomopatológicos das peças cirúrgicas. os doentes operados foram seguidos após a cirurgia num período acima de 10 anos (81% dos casos), sem nenhum casos de recidiva clínica ou através de exames laboratoriais. A incidência de malignidade foi de 6%; quanto às complicaçöes cirúrgicas maiores, houve três casos de paralisia de cordas vocais (um bilateral) e nenhum de hipocalcemia. Finalmente, comparam-se os resultados obtidos com os da literatura revista