Management of substernal and XXXX .

@entity1 @entity13209 @entity944 @entity649 @entity2850 @entity5651 @entity1282 @entity3746
Goiters that descend into the mediastinum can cause respiratory embarrassment, @entity1282 , @entity2850 , @entity3746 , and @entity944 . Although many @entity5651 remain clinically silent, their ability to produce sudden and unpredictable @entity649 is well known. The condition was not considered uncommon in the first half of the twentieth century; some authors reported series of hundreds of thyroidectomies for @entity13209 . Though seen less frequently today, the only effective treatment for @entity5651 is surgical removal. We report our experience with the management of 70 consecutive @entity1 with substernal or @entity13209 . The clinical presentation, preoperative evaluation, operative technique, and results and complications of therapy are discussed. Consideration is also given to the pathogenesis of intrathoracic extension. The transcervical approach for resection is emphasized--even goiters extending to the aortic arch were safely removed without requiring sternotomy. A multidisciplinary team approach, including the surgeon, anesthesiologist, and endocrinologist, is essential. Because of more conservative trends in the selection of @entity1 for thyroidectomy, the incidence of @entity5651 may be increasing.
