Surgical Treatment of Recurrent Multinodular Cervicothoracic Goiter

Background. Mistakes in the diagnosis of thoracic goiter account for 0.2–45 % of all observations. In this regard, consideration of clinical cases of this pathology is relevant. Case report. The article presents an observation of recurrent cervicothoracic goiter from the cervical approach 34 years after the first surgery. An inadequate extent of previous surgery should be considered the cause of the recurrence. In the described observation, the node extended retrosternally at a depth of 8 cm, was fused with paratracheal tis-sue, was supplied with blood from the right internal mammary artery and was intimately adjacent to the aortic arch, which complicated surgical intervention from the classical approach. An atypical course of coronary heart disease was noted as a manifestation of recurrent thyrotoxicosis. The lack of effect from conservative therapy for “cardiogenic” pathology could be associated with intrathoracic goiter location and the occurrence of subclinical thyrotoxicosis. Thy-roidectomy with mandatory intrathoracic nodectomy with the elimination of all thyrotoxicosis symptoms is justified. Thoracic goiter extending below the aortic arch can be removed through a cervical approach. Taking into account the peculiarities of the blood supply and other surgical risks, the intrathoracic location of the node does not exclude the continuation of the surgery from thoracic approaches, such as manubriotomy, sternotomy or lateral thoracotomy.