1Postgraduate, Department of Surgery, Sree Balaji Medical College & Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, 600044, India. ORCID iD: 0009-0005-2531-3083. Email: geeths.smily25@gmail.com
2*Assistant Professor, Department of Surgery, Sree Balaji Medical College & Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, 600044, India. ORCID iD: 0009-0008-1103-9185. Email: athleticsurgeon@gmail.com
3Professor, Department of Surgery, Sree Balaji Medical College & Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, 600044, India. ORCID iD: 0000-0001-8762-6847. Email: ramalakshmi.gs@bharathuniv.ac.in
4Professor, Department of Surgery, Sree Balaji Medical College & Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, 600044, India. ORCID iD: 0000-0001-6623-6751. Email: ragupathy.t@bharathuniv.ac.in
Objective: Retrosternal goitre is the fall of thyroid tissue below the thoracic inlet, which may necessitate a sternotomy if the mediastinal component is substantial or adjacent to major arteries. Safe surgical care requires proper preoperative evaluation and multidisciplinary planning.
Material and Methods: A 55-year-old woman presented with a 6-month history of gradually progressing anterior neck edema, no compressive symptoms, or thyroid dysfunction. A thyroid tumor of 10 × 8 × 3 cm was found to be uneven and bosselated, with an impalpable lower border. Thyroid function tests were normal, and Fine-needle aspiration cytology revealed characteristics compatible with a benign multinodular goiter classified as Bethesda Category II. Contrast-enhanced computed CT revealed significant thyroid enlargement with left-sided retrosternal extension up to the D7 vertebral level, touching the aorta but lacking vascular encasement. Due to substantial inferior mediastinal extension, a multidisciplinary team decided to perform a combination cervical approach with median sternotomy.
Results: The mediastinal component was mobilized under direct vision, allowing for full thyroid resection. The specimen weighed 450 g and had dimensions of 12 x 12 x 5 cm. Except for transitory hypocalcaemia, which recovered with oral supplements, postoperative recovery went smoothly. There were no recurring laryngeal nerve palsies. The patient was discharged on the ninth surgical day and is still symptom-free one year later, with no residual disease seen on imaging.
Conclusion: Median sternotomy may be necessary for safe and complete resection of massive retrosternal multinodular goitres extending beyond the aortic arch. Multidisciplinary collaboration improves surgical outcomes and patient safety.
Keywords: Retrosternal goitre; Multinodular goitre; Mediastinal extension; Median sternotomy; Thyroidectomy
How to cite this article: Geetha Lakshmi N, Ganesh Guru K, Ramalakshmi V, Raghupathy T. The Hidden Neck Mass: Unmasking a Giant Retrosternal Multinodular Goitre. Int J Drug Deliv Technol. 2026;16(16s): 285-290. DOI: 10.25258/ijddt.16.16s.31
Source of support: Nil.
Conflict of interest: None