RETROSTERNAL GOITERS STUDY ON 218 OPERATED PATIENTS

The authors are presenting a retrospective study on 218 retrosternal g oiters operated between 1968 and 1991. 33 % of the goiters were incide ntally discovered on a plain X-ray of the chest. Symptoms of compressi on were present in 50,5 % of patients and hyperthyroidism in 16,5 %. R espiratory manifestations were more frequent and more severe in patien ts aged 70 and more. Moreover 90 % of those old patients were symptoma tic. Goiters migrated anteriorly in 57,7 % of cases, posteriorly in 33 ,9 %, both anteriorly and posteriorly in 5,5 %. Type of migration was unknown in 2,5 %. 3,7 % were malignant. 27 patients with respiratory s ymptoms received corticosteroids to reduce the airway compression. Amo ng 52 patients with hyperthyroidism, 36 were given antithyroid drugs. Among them, some received corticosteroid drugs in order to reduce risk s of mediastinal compression. A simple cervicotomy was adequate in 92, 7 % of case and was completed by sternotomy in 7,3 %. The operation wa s iterative for relapsing or forgotten thoracic goiters in 24 cases. M orbidity was slight even for sternotomized patients. Mortality was not ed in 2 cases (0,9 %) one of them operated on for poorly-differenciate d and suffocating carcinoma of the thyroid. We advise a straightforwar d surgical attitude as a result of the slight morbidity and mortality, even in sternotomized patients in order to avoid severe compressive c omplications of the airways.