RETROSTERNAL GOITER

• Retrosternal goiter tends to arise from the slow growth of a multinodular (lower pole) down into the mediastinum.
• The nodular goiter is sucked in superior mediastinum by-

1. Negative intrathoracic pressure
2. Pretracheal muscles are strong in men
3. Strong neck, obesity, strong ribbon muscles

CLINICAL FEATURES-

• Asymptomatic
• Dyspnea, dysphagia
• Pemberton’s sign- engorged veins of neck and chest wall (The hands are raised above the head, and the arms touch the ears)

CLASSIFICATION-

1. Primary- arises from ectopic thyroid tissue in the mediastinum
2. Secondary- common variety

II) According to clinical types-

1. Substernal (most common type)
2. Intrathoracic
3. Plunging goiter

INVESTIGATIONS

• X- ray shows tracheal compression and deviation
• CT scan shows localization, size and extent.

TREATMENT-

• Surgical excision is the treatment of choice
• If gland is fixed, immobile and too large – midline stenotomy is performed
• No antithyroid drugs and radioiodine should be given to thyrotoxicosis with retrosternal goiter.