Editing Goitre (section)

== Complications ==

* Substernal goitre
** A goitre with a significant      proportion of the gland extending inferiorly through the thoracic inlet      and into the mediastinum
** Can extend either into the      anterior mediastinum or posteriorly to the great vessels, trachea and      RLN, or exist as an isolated mediastinal goitre with no connection to the      normal cervical orthotopic gland and with unique blood supply from the      chest
** More likely to be associated      with local compressive symptoms - shortness of breath, orthopnoea,      dysphagia - because the thoracic inlet is a fixed bony space
** Tracheal compression can      cause fairly severe limitations in ventilatory flow (Poiseuille Law)
** Obstructive symptoms -      require removal/ablation of thyroid
** Asymptomatic substernal      goitre
*** Surgery - if extends below       level of brachiocephalic vein
**** Could continue to grow
**** Suppressive therapy is        ineffective
**** Becoming worse surgical        candidates over time
**** Risk of cancer
**** Risk of haemorrhage into        goitre
*** Observation otherwise
**** Should have normal        flow-volume loop
**** Serial CT - initially one        year
*** Poor operative candidates -       radioiodine ablation

[[Category:Endocrine]]