ВИПАДОК ОПЕРАТИВНОГО ЛІКУВАННЯ ЗАГРУДИННОГО ЕУТИРЕОЇДНОГО ЗОБУ З ЗАСТОСУВАННЯМ ВІДКРИТОГО ТА ТОРАКОСКОПІЧНОГО ДОСТУПІВ

Eduard Khoroshun; Vitaly Makarov; Kateryna Misiura; Volodymyr Nehoduiko; Yurii Bunin; Viktor Dubovyk; Evgen Tytov

doi:10.21856/j-PEP.2025.3.08

A CASE OF SURGICAL TREATMENT OF RETROSTERNAL EUTHYROID GOITER USING OPEN AND THORACOSCOPIC APPROACHES

Authors

Khoroshun E. M. Military Medical Clinical Center of the Northern District of the Medical Forces Command; Kharkiv National Medical University, Kharkiv, Ukraine https://orcid.org/0000-0003-1258-1319
Makarov V. V. Military Medical Clinical Center of the Northern District of the Medical Forces Command; Kharkiv National Medical University, Kharkiv, Ukraine https://orcid.org/0000-0002-4224-0294
Misiura K. V. SI «V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine», Kharkiv, Ukraine https://orcid.org/0000-0002-0258-9109
Nehoduiko V. V. Military Medical Clinical Center of the Northern District of the Medical Forces Command; Kharkiv National Medical University, Kharkiv, Ukraine https://orcid.org/0000-0003-4540-5207
Bunin Yu. V. Military Medical Clinical Center of the Northern District of the Medical Forces Command, Kharkiv, Ukraine https://orcid.org/0000-0002-1807-437X
Dubovyk V. M. SI «V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine», Kharkiv, Ukraine https://orcid.org/0000-0003-4260-6070
Tytov E. V. Military Medical Clinical Center of the Northern District of the Medical Forces Command; Kharkiv National Medical University, Kharkiv, Ukraine https://orcid.org/0000-0002-1999-3052

DOI:

https://doi.org/10.21856/j-PEP.2025.3.08

Keywords:

retrosternal euthyroid goiter, combined approaches, surgical treatment

Abstract

The aim is to demonstrate the features of surgical treatment of retrosternal euthyroid goiter using a combination of open and thoracoscopic approaches.

Materials and methods

Patient M., 32 years old, turned to the endocrinologist of the State Institution "Institute of Endocrine Pathology named after V.Ya. Danylevskyi of the National Academy of Medical Sciences of Ukraine" with complaints of discomfort in the neck area, feeling of discomfort during the act of swallowing, general weakness, shortness of breath. From the anamnesis it is known that she considers herself sick for about 6 months, when the above-mentioned complaint was first detected. She was examined on an outpatient basis, general blood and urine tests were performed, a biochemical blood test, a blood coagulogram, blood group and Rh factor, blood hormones, an ultrasound of the neck, multispiral computed tomography of the neck and chest organs with and without contrast, and an electrocardiogram. She was examined by an endocrinologist and a therapist. The diagnosis was made: Diffuse eutheroid retrosternal goiter of the 3rd degree. She sought medical help at the Military Medical Clinical Center of the Northern Region. She was examined by a surgeon. She was hospitalized in the endoscopic surgery department for planned surgical treatment. Locally: the anterior surface of the neck is slightly enlarged. On palpation, the left lobe of the thyroid gland is enlarged, soft and elastic in consistency, painless. Regional lymph nodes are not palpable. Surgical intervention Transverse colotomy. Right-sided extended hemistrumectomy. Video-assisted thoracoscopy on the right. Removal of the retrosternal component of the goiter. Drainage of the posterior superior mediastinum and right pleural cavity according to Bulau.

The diagnosis was confirmed by the data of histological examination of the removed thyroid gland.

Results

According to MSCT of the neck and OGK with contrast, the presence of a retrosternal goiter measuring 120×150mm was detected, which spread along the mediastinum on the right to the root of the right lung.

The following surgical interventions were performed: Transverse colotomy. Right-sided extended hemistrumectomy. Right VATS. Removal of the retrosternal component of the goiter. Drainage of the retro-superior mediastinum and right pleural cavity according to Buelau.

Histological examination data confirm the diagnosis of goiter.

Postoperative diagnosis: Nodular euthyroid goiter of the III degree with partial retrosternal localization and tracheal compression.

In the postoperative period, the drainage from the pleural cavity was removed on the 3rd day after surgery, from the posterior superior mediastinum on the 4th day, on the 5th day she was discharged for outpatient treatment, the sutures were removed on the 10th day. A month after the surgery, hormone replacement therapy was prescribed.

Conclusions

Planning of surgical intervention for retrosternal goiter is based on MSCT data and plays a major role in choosing the method of surgical intervention. The use of a combined open cervical and minimally invasive thoracoscopic approach allows to minimize surgical trauma and leads to better cosmetic results. The use of minimally invasive technologies in the surgical treatment of retrosternal goiter should be implemented in specialized hospitals with the availability of appropriate equipment and specialists.

Keywords: retrosternal euthyroid goiter, surgical treatment, combined approaches.

References

1. Zavgorodnij SM, Percov VI, Telushko JaV, et al. Klin Endokrynologija Endokryn Hirurgija 2016;3(55): 91-94, available at: http://jcees.endocenter.kiev.ua/article/view/77659

2. Bondar JaJa, Fajfura VV. Patologichna anatomija ta patologichna fiziologija, Ternopil', 2019: 494 p.

3. Tymchenko AM, Misjura KV. Mizhnar Endokrynol Zhurn 2007;3(9): 32-35.

4. Hazijev VV, Dubovyk VM, Korchagin JeP, et al. Klin Endokrynologija Endokryn Hirurgija 2019;3(67): 78-79, available at: http://nbuv.gov.ua/UJRN/kee_2019_3_18

5. Cullinane C, Evoy D, McDermott E, Prichard R. World J. Surg. Res 2021;4: 1328, available at: https://www.surgeryresearchjournal.com/open-access/the-surgical-management-of-retrosternal-goiter-an-ongoing-controversy-7805.pdf

6. Francesco Paolo Prete, Giuseppe Massimiliano De Luca, Lucia Ilaria Sgaramella, et al. J Clin Med 2025;14(2): 489. https://doi.org/10.3390/jcm14020489

7. Gaitan E, Nelson NC, Poole GV. World J Surg 1991;15(2): 205-215. https://doi.org/10.1007/BF01659054

8. Grubnik VV, Parfentiev RS, Kosovan VM, Parfentieva ND. Klin Khirurhiia 2021; 88(1-2): 45-49. https://doi.org/10.26779/2522-1396.2021.1-2.45

9. Knobel M. J Endocrinol Invest 2021;44(4): 679-691. https://doi.org/10.1007/s40618-020-01391-6

10. Manouchehr Aghajanzadeh, Mohammad Reza Asgary, Fereshteh Mohammadi, et al. Family Med Prim Care 2018;7(1): 224-229. https://doi.org/10.4103/jfmpc.jfmpc_286_17

11. Hanson MA, Shaha AR, Wu JX. Best Pract Res Clin Endocrinol Metab 2019;33(4): 101312. https://doi.org/10.1016/j.beem.2019.101312

12. Pearce EN, Zimmermann MB. Thyroid 2023;33(2): 143-149. https://doi.org/10.1089/thy.2022.0454

13. Randolph GW, Shin JJ, et al. Laryngoscope 2011;121(1): 68-76. https://doi.org/10.1002/lary.21091

14. Shahabaddin Sorouri, Samira Akbarianrad, Maryam Naseri. Clin Case Reports 2024;12(6): e8918. https://doi.org/10.1002/ccr3.8918

15. Yildirim Simsir I, Cetinkalp S, Kabalak T. Med Princ Pract 2020;29(1): 1-5. https://doi.org/10.1159/000503575

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Published

2025-09-15

How to Cite

Khoroshun, E., Makarov, V., Misiura, K., Nehoduiko, V., Bunin, Y., Dubovyk, V., & Tytov, E. (2025). A CASE OF SURGICAL TREATMENT OF RETROSTERNAL EUTHYROID GOITER USING OPEN AND THORACOSCOPIC APPROACHES . Problems of Endocrine Pathology, 82(3), 59–66. https://doi.org/10.21856/j-PEP.2025.3.08