Forget the Thyroid after Surgery? Wrong It could still be there
The “forgotten” goiter after total thyroidectomy
“Forgotten” goiter is an extremely rare disease which is defined as a mediastinal thyroid mass found after total thyroidectomy.
PRESENTATION OF CASE
We report two cases with forgotten goiter. One underwent total thyroidectomy due to thyroid papillary cancer and TSH level was in normal range one month after surgery. The thyroid scintigraphy scan revealed mediastinal thyroid mass. The second case underwent total thyroidectomy due to Graves’ disease and TSH level was low after surgery. At postoperative seventh year, patients were admitted to our Endocrinology Division due to persistent hyperthyroidism and CT scan revealed forgotten thyroid at mediastinum. Both patients underwent median sternotomy and mass excision, there was no morbidity detected after second surgical procedures.
In the majority of cases forgotten goiter is the consequence of the incomplete removal of a plunging goiter. Although in some cases, it may be attributed to a concomitant, unrecognized mediastinal goiter which is not connected to the thyroid with a thin fibrous band or vessels. Absence of signs like mediastinal mass or tracheal deviation in preoperative chest X-ray do not excluded the substernal goiter.
Retrosternal goiter should be suspected if the lower poles could not be palpated on physical examination and when postoperative TSH levels remained unchanged.
n some instances mediastinal portion of RGs is connected to the cervical part with a thin fibrous band, that is why the mediastinal extension is leaved out during cervical exploration.1, 2 Absence of signs like mediastinal mass or tracheal deviation in preoperative chest X-ray causes to leave these cases out.
Forgotten goiter is a rare pathology which can be prevented if particular attention is paid to preoperative imaging and intraoperative management during the first operation. However surgical treatment for forgotten goiter, when performed in specialized centers, is associated with low morbidity.
Forgotten thyroid in the chest after negative thyroid ultrasound.
Iodine Scan shows retrosternal mass. CT shows the mass in the chest
Forgotten thyroid after total thyroidectomy.CT shows substernal residual goiter.
Drawings of substernal goiters