A 50 year old male comes with c/o easy fatiguability, dyspnea & neck swelling. On examination, he demonstrates the following sign. What is the appropriate of this condition?
Surgery transthoracic approach
Radioactive iodine ablation
Surgery transcervical approach
Levothyroxine to suppress TSH
Retrosternal goitre (Substernal/Mediastinal/Intrathoracic) * If > 50% of thyroid tissue is located below the opening of thoracic cage.* Most patients are asymptomatic* Diagnosed incidentally on radiological investigations Signs & Symptoms- MC symptom - Dyspnea (due to compression of trachea), in night- Dysphagia (due to compression of esophagus)- Hoarseness of voice (due to compression of Recurrent laryngeal nerve)- Dilated veins over Anterior chest wall.- PEMBEON sign- positive* If bilateral upper limb elevated above forehead, facial puffiness and facialcongestion seen Treatment- Thyroidectomy by cervical incision Thyroidectomy is indicated for retrosternal goitre for patients with clinical symptoms (stridor or dysphagia) and/or radiological evidence of significant tracheal narrowing, oesophageal compression or SVC syndrome. - Radioisotopes used* T1/2 of I 123 - 13 hours (shoer fall life) - so used for diagnostic purposes (RAI SCAN)* T1/2 of I 131 - 8 days (Longer half-life) - so used for therapeutic purposes (RAI ABLATION). Radio Active Iodine Ablation- I131 emits beta- rays (90%) and gamma- rays (10%)- Beta rays are responsible for Therapeutic effects (ablation)- Depth of penetration of beta rays - 0.5 mm (Ablates only thyroid, even parathyroid are safe)- Gamma rays are responsible for side effects- Gamma rays are used in Tracer studies - Gamma probe can be used for identifying the area that emits gamma rays. So, useful in Radioactive Iodine scan - Absolute contraindication of RAI Ablation (because gamma rays are emitted)* Pregnancy* Lactation
General Surgery