Surgery of Retrosternal Thyroid: Evaluation of 36 Cases

Objective: Retrosternal thyroid is the presence of thyroid tissue in the mediastinum either by enlarging of the cervical or by an ectopic mediastinal thyroid. Surgery for a retrosternal thyroid has technical differences than conventional cervical thyroid surgery and has a higher risk of complications. This paper aims to analyze the cases with retrosternal thyroid and to evaluate the outcomes of the surgery. Materials and Methods: Retrospective analysis in terms of age, sex, clinical course, thyroid hormone levels, parathormone (PTH) levels, diagnostic methods, and fine needle aspiration cytology (FNAC) results and complications of 36 cases that underwent surgery was performed. Results: In addition to routine evaluation for thyroid pathology, computerized tomography was used for each patient. Thirty-four surgeries were completed with a cervical incision, one with a sternotomy and one with a thoracotomy. Four patients (11.1%) experienced temporary postoperative hypocalcemia, and one patient had a transient vocal cord immobility. Neither permanent hypocalcemia nor vocal cord paralysis was present in any of the patients postoperatively. Conclusion: Planning surgery as early as possible is suggested to avoid compression symptoms and possible malignancy. Cervical approach is mostly enough for the majority of patients; however, in case of a need of an additional (transthoracic) approach, multidisciplinary planning with thoracic surgeons is proposed. The risk of complications in experienced centers is parallel to cervical thyroidectomy.