Katlic M R, Wang C A, Grillo H C
Ann Thorac Surg. 1985 Apr;39(4):391-9. doi: 10.1016/s0003-4975(10)62645-8.
The literature on substernal goiter from the seventeenth century to the present is reviewed. Substernal goiter may be defined as any thyroid enlargement that has its greater mass inferior to the thoracic inlet. Truly ectopic mediastinal goiters are rare, and most substernal goiters arise from and maintain some attachment to the cervical thyroid gland. Patients are generally in the fifth decade of life, and women predominate. Most patients experience dyspnea, stridor, or dysphagia, but 15 to 50% are asymptomatic; symptoms are often positional, and acute stridor may occur. Ten to twenty percent have no cervical mass or tracheal deviation on examination, and virtually all patients are euthyroid. Standard chest roentgenograms are often diagnostic, but computed tomographic or radioactive iodine scans may be helpful. The presence of a substernal goiter in all but the highest-risk patients is an indication for resection, usually through a cervical collar incision; an occasional patient will require sternotomy or thoracotomy. Death or major complications should be rare postoperatively. Substernal goiters are adenomatous and benign, but carcinoma occurs in 2 to 3% and may be occult. Patients should be followed closely, as these goiters may recur.
回顾了从17世纪至今有关胸骨后甲状腺肿的文献。胸骨后甲状腺肿可定义为任何甲状腺肿大，其大部分肿块位于胸廓入口下方。真正的异位纵隔甲状腺肿很少见，大多数胸骨后甲状腺肿起源于颈部甲状腺并与之保持某种连接。患者通常处于五十多岁，女性居多。大多数患者有呼吸困难、喘鸣或吞咽困难，但15%至50%无症状；症状常与体位有关，可能出现急性喘鸣。10%至20%的患者检查时无颈部肿块或气管偏移，几乎所有患者甲状腺功能正常。标准胸部X线片常可诊断，但计算机断层扫描或放射性碘扫描可能有帮助。除风险最高的患者外，胸骨后甲状腺肿的存在是手术切除的指征，通常通过颈部领式切口；偶尔有患者需要胸骨切开术或开胸术。术后死亡或严重并发症应罕见。胸骨后甲状腺肿为腺瘤性且良性，但2%至3%会发生癌变，可能为隐匿性。应密切随访这些患者，因为这些甲状腺肿可能复发。
