A 50 year old male comes with c/o easy fatiguability, dyspnea & neck swelling. On examination, he demonstrates the following sign. What is the appropriate of this condition?
Retrosternal goitre (Substernal/Mediastinal/Intrathoracic) * If > 50% of thyroid tissue is located below the opening of thoracic cage.* Most patients are asymptomatic* Diagnosed incidentally on radiological investigations Signs & Symptoms- MC symptom - Dyspnea (due to compression of trachea), in night- Dysphagia (due to compression of esophagus)- Hoarseness of voice (due to compression of Recurrent laryngeal nerve)- Dilated veins over Anterior chest wall.- PEMBEON sign- positive* If bilateral upper limb elevated above forehead, facial puffiness and facialcongestion seen Treatment- Thyroidectomy by cervical incision Thyroidectomy is indicated for retrosternal goitre for patients with clinical symptoms (stridor or dysphagia) and/or radiological evidence of significant tracheal narrowing, oesophageal compression or SVC syndrome. - Radioisotopes used* T1/2 of I 123 - 13 hours (shoer fall life) - so used for diagnostic purposes (RAI SCAN)* T1/2 of I 131 - 8 days (Longer half-life) - so used for therapeutic purposes (RAI ABLATION). Radio Active Iodine Ablation- I131 emits beta- rays (90%) and gamma- rays (10%)- Beta rays are responsible for Therapeutic effects (ablation)- Depth of penetration of beta rays - 0.5 mm (Ablates only thyroid, even parathyroid are safe)- Gamma rays are responsible for side effects- Gamma rays are used in Tracer studies - Gamma probe can be used for identifying the area that emits gamma rays. So, useful in Radioactive Iodine scan - Absolute contraindication of RAI Ablation (because gamma rays are emitted)* Pregnancy* Lactation
Surgery transthoracic approach
Radioactive iodine ablation
Surgery transcervical approach
Levothyroxine to suppress TSH
General Surgery