1/10. A giant retrosternal goiter with severe tracheal compression and superior vena cava syndrome: an operative experience.The peculiarities in the operation of a giant retrosternal goiter with severe tracheal compression and superior vena cava syndrome are highlighted in this report of a 53 year-old female with a large anterior neck swelling interfering with normal breathing and swallowing. From the initiation of the neck incision, mobilization of the gland and performing the subtotal excisions there was troublesome bleeding. pneumothorax resulting after delivery of the massive retrosternal portion was managed with an underwater-seal drainage tube.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/10. Substernal goiter: an unusual cause of respiratory failure after coronary artery bypass grafting.Substernal goiter can cause extrathoracic upper airway obstruction. Since cardiopulmonary bypass results in a systemic inflammatory response syndrome characterized by an increase in capillary permeability and edematous changes in many tissues including the thyroid gland, an existing nonobstructive substernal goiter may become obstructive postoperatively. We describe the case of a patient with an asymptomatic substernal goiter who required urgent thyroidectomy for tracheal obstruction after elective coronary artery bypass grafting. To the best of our knowledge, ours is the 1st such case reported in the English-language medical literature. This case illustrates that, in cases of acute postoperative respiratory failure after open heart surgery, tracheal obstruction caused by enlarged substernal goiter should be considered in the differential diagnosis.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
3/10. Primary intrathoracic goitre.A right paratracheal mass in a 56-year-old man was found to be a primary intrathoracic goitre. Pathological examination showed nodular hyperplasia with focal lymphocytic thyroiditis. Enlarged mediastinal thyroid tissue may result from extension of a cervical goitre into the chest and is then called secondary or may develop from ectopic thyroid tissue located in the mediastinum and is then called primary. In the latter case blood supply comes from local intrathoracic vessels and no connections with the cervical gland are observed. Differentiation can be made by ultrasonography, CT scanning or radioisotope scanning. Primary goitres are best operated on by way of a thoracotomy as troublesome mediastinal bleeding may occur which is difficult to control from a cervical collar incision.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
4/10. hyperthyroidism caused by a toxic intrathoracic goiter with a normal-sized cervical thyroid gland.The rare presentation of hyperthyroidism caused by an intrathoracic goiter with a normal-sized cervical thyroid gland is described. The toxic intrathoracic goiter demonstrated avid uptake of [131I] and [99mTc]pertechnetate, with comparatively faint isotopic accumulation seen in the cervical thyroid. A chest roentgenogram and radioisotope scan should be mandatory in cases of hyperthyroidism having no cervical thyroid enlargement to explore the possibility of a toxic intrathoracic goiter.- - - - - - - - - - ranking = 5keywords = gland (Clic here for more details about this article) |
5/10. Severe thyrotoxicosis caused by an ectopic intrathoracic goiter.The case of a 71-year-old woman with severe thyrotoxicosis due to an ectopic multinodular intrathoracic goiter is described. Previously reported cases with intrathoracic ectopic thyroid tissue were either nontoxic, or, if thyrotoxic, were a direct continuation of the tissue of the normally located gland. This mass was proved to be of thyroid origin using Tc-99m sodium pertechnetate scanning.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
6/10. Sequestered substernal goiter.A young woman with a normally located and only subtly nodular thyroid gland in the neck was found to have a clinically distinct and radioisotopically "cold" anterior mediastinal mass, which proved to be a benign colloid adenoma. While this constellation of findings usually suggests the presence of a nonthyroidal neoplasm, eg, lymphoma, thymoma, or teratoma, our case illustrates that sequestered benign nodular goiter should also be considered in the differential diagnosis. Clinical clues, such as a nodular thyroid gland, movement of the mass with deglutition, and a family history of nodular goiter, should suggest this possibility. A characteristic computed tomographic appearance may also prove useful in recognition of this rare disorder.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
7/10. Upper gastrointestinal hemorrhage from downhill esophageal varices.Two cases of proximal esophageal varices due to a primary and a recurrent goiter are reported. One of the patients presented with massive upper gastrointestinal hemorrhage 44 years after subtotal resection of a thyroid gland. "Downhill" esophageal varices may serve as collaterals either to bypass superior vena caval obstruction via azygous vein or to drain the superior systemic system to the portal vein when both the superior vena cava and the azygous vein are occluded. They may also arise, as in our bleeding patient, from previous thyroid surgery without any symptoms of superior vena caval congestion. Therefore, downhill varices should be suspected as the origin of upper gastrointestinal hemorrhage not only in patients with obvious superior vena caval obstruction, buy also in any case of thyroid disease or a history of thyroid surgery. If conservative measures are insufficient, emergency management may include balloon tamponade or endoscopic sclerotherapy.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
8/10. hyperthyroxinemia and hypotriiodothyroninemia with clinical euthyroidism.A clinically euthyroid woman had substernal goiter and thrombocytopenia. There was a striking elevation in serum thyroxine (T4) level when the level of triiodothyronine (T3) ws low, reverse T3 (rT3) was normal I131 uptake was suppressed, and thyroid stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH) was blunted. The elevation of T4 was transient and required no treatment. Postmortem examination revealed a thyroid gland that showed only multinodular goiter. Multiple factors contributed to the dissociation between T4 and T3 levels. There was a lack of clinical symptoms in the face of high T4 and normal T3. The report stresses the need for thorough evaluation of thyroid function in such cases before instituting treatment.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
9/10. Downhill varices: report of a case 29 years after resection of a substernal thyroid gland.A case of varices of the entire esophagus in a patient who had undergone resection of a substernal thyroid gland 29 years previously is reported. Dilated esophageal veins, varices, may serve as collateral channels between the portal and systemic systems. When the superior vena cava is obstructed, blood from the upper extremities and head is returned to the heart via downhill varices. Obstruction of the superior vena cava proximal to the azygos vein results in varices of the upper esophagus. Obstruction distal to the asygos vein, as in this patient, results in varices of the entire esophagus. Portacaval shunt has no place in the management of these patients. Downhill varices should be considered in any patient with superior vena caval obstruction from any cause.- - - - - - - - - - ranking = 5keywords = gland (Clic here for more details about this article) |
10/10. Intrathoracic aberrant thyroid: identification critical for appropriate operative approach.True aberrant thyroid in the chest is a rarely described entity. More commonly, "aberrant" thyroid is a substernal goiter that is an extension of the cervical gland inferiorly and can be removed safely with the classic "collar" incision. Aberrant intrathoracic thyroid typically derives its blood supply from intrathoracic sources and requires an alternate surgical approach for adequate exposure. The ability to identify these rare intrathoracic thyroids is critical for safe surgical excision.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
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