Types of RSG?
- Congenital (rare)
a. Plunging goiter
b. Intrathoracic goiter - Acquired
a. Mediastinal goiter (more common)
Intrathoracic goiter is ?
Completely present in the chest and separated from the main gland . arises from extopic gland and takes blood supply from mediastinal vessels
Mediastinal goiter is ?
Nodule completely in chest but connect to thyroid and takes bl supply from thyroid
What prevents forward extention of goiter?
Sternohyoid and sternothyroid assisted by gravity and –ve ITP
Type of patient of RSG?
Middle aged males ( strong strap muscles and short neck)
Symptoms of RSG?
- ASYMPTOMATIC (accidental discovery CXR)
- Hx of cervical goiter which disappeared but sever obst symtoms
a. Dyspnea cough stridor
b. Dysphagia
c. Dysphonia - Toxic manifestations maybe found
What is pemberston’s sign?
Patient elevates the arm above the level of head. It is considered positive when facial plethora occurs.
What causes skull metastasis in thyroid chapter?
Follicular carcinoma
Ttt of pt with toxic retrosternal goiter?
Subtotal thyroidectomy after preparation by Inderal only NO ANTI THYROID DRUGS to avoid thiouracil goiter
Investigations of RSG?
- Ct (IOC)
- Plain XRAY
a. Show shadow in superior mediastinum ( sometimes calcification of wall) - Isotope scan
a. Help FF ITgoiter from mediastinal tumor - Flow volum loop pulmonary fx
a. Check tracheal compression used to follow progression of disease
DD of shadow in superior mediastinum?
REAL T..
- Retrostenal goiter
- Enlarged LN
- Aortic aneurysm
- Lymphoma
- Thymoma
Ttt of RSG?
Thyroidectomy is the only line of ttt
Incision from where for ttt of RSG?
If congenital from chest
If acquired from neck
Dysphagia with thyroid occurs in?
RRMM
- Retrosternal goiter
- Riedles thyroiditis
- Malignancy ( infiltration of esophagus)
- Myopathy of striated ms of the esophagus in toxic patients
