Archives of Head and Neck Surgery
Archives of Head and Neck Surgery
Original Article Thyroid diseases and tumors

Does the diameter of the thoracic inlet influence the formation of retrosternal goiter?

Leonardo Daniel Manzano Pasquel, Daniel Abreu Rocha, Yasmin Laryssa Moura Guimaraes, Gustavo Fernandes de Alvarenga, Mauricio Kase, Júlia Scomparin Magalhãnes, Regina Lúcia Elia Gomes, Ledo Mazzei Massoni Neto, Renata Lorencetti Mahmoud, Leandro Luongo de Matos, Vergilius José Furtado de Araujo Filho, Claudio Roberto Cernea

Downloads: 0
Views: 192


Introduction: Retrosternal goiter (RSG) can be defined as greater than 50% of the thyroid volume within the thorax. RSG is present in 2-26% of all thyroidectomies, depending on the defining criteria. Objective: Find an association between diameter of the thoracic inlet (TI) and RSG to determine whether the TI would function as a natural anatomical barrier to prevent the passage of the goiters to the thoracic cavity. Methods: A retrospective study was conducted with patients submitted to total thyroidectomy, with goiter greater than 50 cm3, who underwent computed tomography (CT) preoperatively to measure the TI volume. The values obtained from each continuous variable of parametric distribution were organized and described as mean and standard deviation. The distributions were defined as non-parametric by the Kolmogorov-Smirnov test. The Mann-Whitney test was used to compare two sample populations. Results: A total of 173 patients submitted to total thyroidectomy were evaluated, and 54 patients met the inclusion criteria of the study. 85.2% were female, with a mean age of 57 years. The mean diameter of the TI was 5679 mm2. 42% of the patients presented some degree of RSG. The distance below the TI ranged from 0.2 to 5 cm. Conclusion: No significant association was found between diameter of the thoracic inlet and retrosternal goiter, demonstrating that RSG can be present regardless of the TI diameter. Statistically significant association was observed between patients with larger thyroid volume and the likelihood of this tissue to extend to the thoracic cavity.


goiter; retrosternal goiter; thoracic approach; thoracic inlet.


1. Neves MCD, Rosano M, Hojaij FC, Abrahão M, Cervantes O, Andreoni DM. Avaliação crítica de 33 pacientes com bócio mergulhante tratados cirurgicamente por cervicotomia. Rev Bras Otorrinolaringol. 2009;75(2):172-6.

2. Perincek G, Avcı S, Çeltikçi P. Retrosternal Goiter: A couple of classification methods with computed tomograpy findings. Pak J Med Sci. 2018;34(6):1494. PMid:30559810.

3. Sakkary MA, Abdelrahman AM, Mostafa AM, Abbas AA, Zedan MH. Retrosternal goiter: The need for thoracic approach based on CT findings: Surgeon’s view. J Egypt Natl Canc Inst. 2012;24(2):85-90. PMid:23582600.

4. Moore KL, Persaud TVN. Embriologia básica. 9. ed. Rio de Janeiro: Elsevier Editorial Ltda; 2016. Capitulo 10, Aparelho Faringeo; p. 99-150.

5. Ellis H. Anatomy of the thyroid and parathyroid glands. Surgery. 2007;25(11):467-8

6. Ziai H, Lebo NL, Kielar AZ, Odell MJ. Can Thyroid Ultrasonography Predict Substernal Extension or Tracheal Compression in Goiters? Can Assoc Radiol J. 2018;69(4):422-9. PMid:30390961.

7. Chávez Tostado KV, Velazquez-Fernandez D, Chapa M, Pantoja Millan JP, Salazar MS, Herrera MF. Substernal goiter: correlation between grade and surgical approach. Am Surg. 2018;84(2):262-266. PMid:29580356.

8. Sormaz İC, Uymaz DS, İşcan AY, Özgür İ, Salmaslıoğlu A, Tunca F, Şenyürek YG, Terzioğlu T. The Value of Preoperative Volumetric Analysis by Computerised jTomography of Retrosternal Goiter to Predict the Need for an Extracervical Approach. Balkan Med J. 2018;35(1):36-42. PMid:28840845.

9. Standring S. Gray’s anatomy: the anatomical basis of clinical practice. 40th ed. London: Churchill Livingston; 2008. 1576 p.

10. Snell RS. 2012. Clinical anatomy by regions. 8th ed. Baltimore: Lippincott Williams & Wilkins. 944 p.

11. Nayak SB. Thoracic inlet or thoracic outlet: Which one is which in anatomical and clinical literature? Anat Sci Educ. 2014;7(2):167-167. PMid:24136863.

12. Huins CT, Georgalas C, Mehrzad H, Tolley NS. A new classification system for retrosternal goitre based on a systematic review of its complications and management. Int J Surg. 2008;6(1):71-6. PMid:17416216.

13. Grainger J, Saravanappa N, D’souza A, Wilcock D, Wilson PS. The surgical approach to retrosternal goiters: The role of computerized tomography. Otolaryngol Head Neck Surg. 2005;132(6):849-51. PMid:15944553.

5e26f3910e88253b470c3b21 archives Articles
Links & Downloads

Arch. Head Neck Surg.

Share this page
Page Sections