Huge toxic goiter extending to the posterior mediastinum; Case report with literature review

INTRODUCTION: Retrosternal goiter may occur in up to 7% of the cases, most of them extend to the anterior mediastinum, extension to the posterior mediastinum is very rare. It causes compression on mediastinal structures such as the trachea, the bronchi, the esophagus, and great vessels. The diagnosis is done mostly by CT scan. Most cases need surgery which is done by the combined cervical and the thoracic incisions. CASE PRESENTATION: A 70-year-old man had history of thyroid enlargement for 10 years which was hyper-functioning and controlled with medical therapy. For the last 2 months the patient was complaining from dyspnea especially during supine posture and dysphagia. CT-scan showed huge extension of the thyroid gland to the posterior mediastinum causing compression over the tracheal and the esophagus. Surgery done through both cervical incision and manubriotomy and the huge thyroid gland extracted. The patient had uneventful recovery with no postoperative complications. CONCLUSION: Retrosternal goiter causes airway compromise in most patients. Surgery for such cases is a challenging procedure with higher rate of complications, CT-scan is the most single valuable tool in selecting patients for sternotomy before surgery but the final decision for sternotomy is best done during surgery. A team work between a thyroid surgeon and a thoracic surgeon has better results.