SURGICAL TREATMENT OF RECURRENT MULTI-NODULAR CERVICOTHORACIC GOITER
https://doi.org/10.57256/2949-0715-2024-2-39-44
Abstract
Relevance. Misdiagnosis of retrosternal goiter occurs in 0,2 to 45 % of patients.
Case descriptions. The authors present a case of recurrent cervical goiter from cervical exposure 34 years after the first surgical intervention. The reason for the goiter recurrence was considered as an inadequate previous surgery. In the presented case report, the node extended retrosternally to a depth of 8 cm, was fused to the paratracheal tissue, was supplied with blood from the right internal thoracic artery and was intimately adjacent to the aortic arch, which complicated surgical intervention from the classical approach. An atypical course of coronary heart disease was described as a manifestation of recurrent thyrotoxicosis. The lack of effect from conservative therapy for “cardiogenic” pathology could be due to the intrathoracic location of the goiter and the occurrence of subclinical thyrotoxicosis.
Surgical intervention is reasonable to perform in the extent of thyroidectomy with mandatory removal of intra-thoracic nodes with the elimination of all symptoms of thyrotoxicosis. A retrosternal goiter with a spread below the aortic arch can be removed from the cervical exposure.
About the Authors
Elena A. Ilicheva
Irkutsk Scientific Centre of Surgery and Traumatology
Russian Federation
Russian Federation
Dr. Sci. (Med.), professor, Head of Scientific Department, Irkutsk Scientific Centre of Surgery and Traumatology, Russia, 664003, Irkutsk, st. Fighters of the Revolution, 1
Daria V. Lebedeva
Irkutsk State Medical University, Russia, 664003, Irkutsk
Russian Federation
Russian Federation
assistant Lecturer at Hospital Surgery Department, Irkutsk State Medical University, Russia, 664003, Irkutsk, st. Krasnogo Vosstaniya, 1
Eugene G. Grigoryev
Irkutsk State Medical University, Russia, 664003, Irkutsk
Irkutsk Scientific Centre of Surgery and Traumatology
Russian Federation
Russian Federation
Dr. Sci. (Med.), Professor, Scientific Head, Irkutsk Scientific Centre of Surgery and Traumatology, Russia, 664003, Irkutsk, st. Fighters of the Revolution, 1; Head Of Hospital Surgery Department, Irkutsk State Medical University, Russia, 664003, Irkutsk, st. Krasnogo Vosstaniya, 1
References
1. Del Rio P., Polistena A., Chiofalo M.G. et al. Management of surgical diseases of thyroid gland indications of the United Italian Society of Endocrine Surgery (SIUEC). Updates Surg. 2023;75(6):1393-1417. DOI:10.1007/s13304-023-01522-7
2. Романчишен А.Ф., Романчишен Ф.А., Карпатский И.В., Вабалайте К.В. Ургентные хирургические вмешательства при заболеваниях щитовидной железы и осложнениях раннего послеоперационного периода. Педиатр. 2013;4(4):103–115 [Romanchishen A.Ph., Romanchishen Ph.A., Karpatsky I.V., Vabalayte K.V. Urgent surgery for thyroid diseases and complications of early postoperative period. Pediatrician. 2013;4(4):103–115 (In Russian)] https://www.elibrary.ru/download/elibrary_21399702_75931374.pdf [дата доступа: 02.05.2024].
3. Заривчацкий М.Ф., Денисов С.А., Блинов С.А. и др. Диагностика и лечение рецидивного послеоперационного зоба. Вестник хирургии имени И.И. Грекова. 2017;176(1):52–55. [Zarivchatskiy M.F., Denisov S.A., Blinov S.A. et al. Diagnostics and treatment of recurrent postoperative goiter. Grekov's Bulletin of Surgery. 2017;176(1):52-55. (In Russ.)]. DOI:10.24884/0042-4625-2017-176-1-52-55
4. Díez J.J., Iglesias P. Prevalence of thyroid dysfunction and its relationship to income level and employment status: a nationwide population-based study in Spain. Hormones (Athens). 2023;22(2):243-252. DOI:10.1007/s42000-023-00435-9
5. Unlu M.T., Aygun N., Kostek M. et al. Substernal goiter: from definitions to treatment. Sisli Etfal Hastan Tip Bul. 2022; 56(2):167-176. DOI:10.14744/SEMB.2022.30806
6. Uludag M., Unlu M.T., Aygun N., Isgor A. Surgical treatment of substernal goiter. Part 2: cervical and extracervical approaches, complications. Sisli Etfal Hastan Tip Bul. 2022;56(4):439-452. DOI:10.14744/SEMB.2022.41103
7. Sandasecra S., Yahya M.M., Zuhdi Mamat A. et al. A monster in the chest: a tale of a goiter. Cureus. 2022;14(6):e25827. DOI:10.7759/cureus.25827
8. Пиксин И.Н., Давыдкин В.И., Вилков А.В. и др. Многоузловой и конгломератный зоб, диагностика и хирургическая тактика. Научное обозрение. Медицинские науки. 2019;2:15-20 [Piksin I.N., Davydkin V.I., Vilkov A.V. et al. Conglomerate and multinodular goiter, diagnosis and surgical tactics. Scientific Review. Medical Sciences. 2019;2:15-20 (In Russian)]. https://science-medicine.ru/ru/article/view?id=1076 [дата доступа: 02.05.2024].
9. Mu L., Ren C., Xu J. et al. Total versus near-total thyroidectomy in Graves' disease: a systematic review and meta-analysis of comparative studies. Gland Surg. 2021;10(2):729-738. DOI:10.21037/gs-20-757
10. Лукьянов С.В., Чаплыгина Е.В., Кучиева М.Б. и др. Анатомическая вариабельность щитовидной железы как фактор риска развития рецидива болезни Грейвса. Современные проблемы науки и образования. 2023;3:110. [Lukyanov S.V., Chaplygina E.V., Kuchieva M.B. et al. Anatomical variability of the thyroid gland as a risk factor for the development of recurrence of Graves’ disease. Modern problems of science and education. Surgery. 2023;3:110 (In Russian)]. DOI:10.17513/spno.32611.
11. Thomusch O., Sekulla C., Billmann F. et al. Risk profile analysis and complications after surgery for autoimmune thyroid disease Prospective Evaluation Study of Thyroid Surgery (PETS 2) Study Group. Br J Surg. 2018;105:677-685. DOI: 10.1002/bjs.10770
12. Bojic T., Paunovic I., Diklic A. et al. Total thyroidectomy as a method of choice in the treatment of Graves’ disease – analysis of 1432 patients. BMC Surg. 2015;15:39. DOI: 10.1186/s12893-015-0023-3
13. Меньков А.В. Рецидив узлового зоба после тканесохранющих операций на щитовидной железе. В сборнике трудов «Хирургическая коррекция эндокринных нарушений». Рязань. 2017;83–86 [Menkov A.V. Recurrence of nodular goiter after organ-preserving operations on the thyroid gland. In: Surgical correction of endocrine disorders: proceedings. Ryazan. 2017;83–86 (In Russian)]. https://www.elibrary.ru/download/elibrary_28793077_65355660.pdf [дата доступа 02.05.2024]
Supplementary files
Review
For citations:
Ilicheva E.A., Lebedeva D.V., Grigoryev E.G. SURGICAL TREATMENT OF RECURRENT MULTI-NODULAR CERVICOTHORACIC GOITER. Baikal Medical Journal. 2024;3(2):39-44. (In Russ.) https://doi.org/10.57256/2949-0715-2024-2-39-44
Views:
533
