Thoracic surgical approach for retrosternal ectopic thyroid tissue after cervical total thyroidectomy: Case Report and Review of literature.

Abstract

Thyroidal organogenesis is controlled by specific transcription factors; alterations in their ex-pression can cause developmental abnormalities like ectopia of the gland. Ectopic thyroid tissue can be found anywhere along the line of the obliterated thyroglossal duct, from the tongue to the diaphragm. The thoracic cavity is the most common non-cervical location. We describe the case report of a "forgotten goiter", a retrosternal ectopic thyroid tissue, detected after a cervical total thyroidectomy. Due to the size of the lesion, anatomical localization, and presence of calcifications, the patient underwent a complete surgical resection of the mass via sternotomy. The histological examination showed benign mediastinal ectopic thyroid tissue. The postoperative course was uneventful and without complications. Any surgical initiative in patients with retrosternal ectopic thyroid tissue must be individualized and based upon the size of the goiter, the characteristics of the mediastinal goiter and its anatomical relationships, the risk of complications and reoperations, the experience of the surgeon, the comorbidities of the patient, and the trajectory of growth in active surveillance. To date, there is no universal consensus on the best surgical approach.