Ectopic Thyroid Mass Separately Present in Mediastinum with Multinodular Goiter

Abstract

 Masses located in the superior mediastinum primarily consist of retrosternal goiters, characterized by their classic presentation of compressive symptoms such as difculty breathing (dyspnea), swallowing (dysphagia), altered voice, or obstructive sleep apnea. The standard approach to managing these goiters involves total thyroidectomy with the removal of any intrathoracic thyroid tissue. However, in some rare instances, these masses may not be a direct extension of the thyroid in the neck and may necessitate a sternotomy—a surgical procedure involving an incision in the sternum—for complete excision of the mediastinal gland. We encountered an intriguing case that initially appeared to be a retrosternal extension of the thyroid gland based on clinical evaluation. However, during the surgical procedure, it was discovered to be a separate and encapsulated mass, requiring a sternotomy for its excision. This unexpected nding underscores the importance of thorough intraoperative assessment and adaptability in surgical management. Retrosternal goiters represent a unique challenge due to their location and potential complications related to compression of nearby structures. While total thyroidectomy is often sufcient for management, instances like the one described in our case report highlight the variability and complexity that surgeons may encounter. Awareness of such variations is crucial for ensuring optimal patient outcomes and minimizing the risk of incomplete excision or damage to adjacent structures.