A retrosternal goiter is an enlarged thyroid gland that extends beyond the sternum with its south pole. Such a condition can cause a lot of discomfort in the patient and hinder normal functioning. Learn how to recognize retrosternal goitre and how to treat such an enlarged thyroid.

Retrosternal goitrecan accompany various thyroid dysfunctions, both hyperthyroidism and hypothyroidism. A normal, he althy thyroid gland (the thyroid gland) is shaped like a butterfly a few centimeters long and sits on the anterior-lower part of the neck. If it grows - in women over 20 cm² and in men over 25 cm² - we call it a goiter. We distinguish:

  • nodular (or nodular, lumpy) goitre
  • parenchymal goiter (homogeneous, enlarged thyroid without focal changes)
  • simple goiter (enlarged thyroid, but made of normal tissue)
  • retrosternal goitre (sometimes also called intra-thoracic, sometimes differentiated from it)

What is the characteristic of retrosternal goiter

For goiter to be defined as retrosternal, it must to some extent simply cross over the sternum. So it no longer lies only "on" the neck, but partially even reaches the chest. It should be about 30-50% of the weight of the thyroid gland. If there is less, it is common to think that we are not talking about retrosternal goiter yet, although some doctors diagnose retrosternal goiter even when even a very small fragment of the thyroid exceeds the level of the jugular notch of the handle of the sternum (this is the characteristic dimple at the bottom of the neck between the collarbones).

While the higher goiter causes a clear cosmetic defect and is treated for this reason, the retrosternal goitre can sometimes be completely invisible. Thus, its diagnosis is also difficult. It happens that a patient comes to the doctor with a persistent cough and the doctor directs him for an x-ray. It is only on the X-ray that you can see that the thyroid gland is growing in the chest. What other symptoms does retrosternal goiter give?

retrosternal goiter - symptoms

As the thyroid gland grows in a place where it shouldn't be there at all, it starts to compress the surrounding structures, such as the trachea, esophagus, blood vessels. So, although the retrosternal goiter does not hurt by itself, it can cause a number of serious ailments:

  • difficulties inbreathing
  • cough, shortness of breath
  • hoarseness (as a result of injury - compression of the recurrent laryngeal nerve)
  • trouble swallowing (dysphagia)
  • superior vena cava syndrome (e.g. redness of the face and neck, protruding eyes, vision problems, redness of the eyes, limb swelling, headaches, imbalance)
  • chest tightness (choking feeling)
  • symptoms typical of overactivity (increased metabolism, palpitations, weight loss, trouble sleeping and concentrating, hot flushes) or hypothyroidism (slow metabolism, weight gain, drowsiness, feeling cold, depressed mood).

Causes of retrosternal goiter

In general, goitre grows due to some abnormalities in the work of the thyroid gland. In the past, the reasons for this state of affairs were seen in the insufficient content of iodine in the diet. However, once this element was added to s alt, the problem was alleviated. Today, diseases are caused by hormonal disorders, sometimes also related to pregnancy, or by autoimmunity. When it comes to specifically the formation of retrosternal goitre, the main reason is the descending of the cervical goiter. However, why this happens is not fully known. The goiter located on the neck grows in size for many years and finally descends into the retrosternal area.

Diagnosis and treatment

The retrosternal goiter is more difficult to treat than the cervical goiter. First of all, it may remain undiagnosed for many years, and only the typical thyroid symptoms that appear in the patient direct the doctor to the right path. However, they do not always occur, because the concentration of thyroid hormones in retrosternal goiter may be increased, decreased, but also normal. Sometimes the diagnosis is made accidentally during a routine chest X-ray.

If a diagnosis is already made: retrosternal goitre, it is necessary to define the exact limits to which it grows, to what extent it oppresses the accompanying organs and whether there are neoplastic changes in it (usually nodules in the goiter are benign). The tests helpful in the diagnosis of retrosternal goiter are computed tomography (CT), magnetic resonance imaging (MRI) and thyroid scintigraphy (isotopic examination of radioactive substances uptake by the thyroid gland, most often with the use of radioactive iodine).

The retrosternal goiter is treated surgically, which consists in the complete removal of the thyroid gland (thyroidectomy), because the pressure on the adjacent structures - e.g. the trachea - must not be too strong. Depending on the exact location and size of the goiter, it may be necessary to dissect the sternum.Sometimes, however, it is impossible, because the goiter's tissue reaches very deep, and in the case of hyperthyroidism, only treatment with radioactive iodine remains.

Thyroid tests

Thyroid examinations can be divided into two parts - examining the level of hormones produced by the thyroid gland and imaging examinations, the most popular of which is ultrasound. Our expert - endocrinologist Marta Kunkel from Medicover Hospital tells what these thyroid tests look like and what they show.

About the authorMarta Uler A journalist specializing in he alth, beauty and psychology. She is also a diet therapist by education. Her interests are medicine, herbal medicine, yoga, vegetarian cuisine and cats. I am a mother of two boys - a 10-year-old and a 6-month-old.

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