Surgical Management of Recurrent and Intrathoracic Goiters

Antonio Sitges-Serra, MD ■ Juan J. Sancho, MD

Recurrent and intrathoracic goiters may pose considerable problems to the surgeon. Surgery is often indicated because local complications are common, and it requires thorough knowledge of the potentially distorted anatomy found at exploration. An appropriate preoperative assessment is essential because thyroid function may be abnormal, there may be sequelae from previous surgery, and precise anatomic definition of the lesion is important for a safe and expeditious operation. Symptoms may differ considerably from those found in uncomplicated goiters and may include airway compression, superior vena cava syndrome, and dysphonia, simulating a thyroid malignancy. Finally, the highest rates of postoperative vocal cord paralysis are reported after surgery for recurrent and complex intrathoracic goiters, suggesting that there is still room for improvement of surgical technique in this area. In this chapter, the pathogenesis, clinical presentation, preoperative assessment, and surgical approach to recurrent and intrathoracic goiters are discussed.

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