Surgical Management of Intrathoracic Goiter Through a Thoracic Approach: Case Report and Literature Review

Intrathoracic goiter is an uncommon condition characterized by partial or complete extension of the thyroid gland into the mediastinum, potentially causing compressive symptoms and significant challenges during surgical management. Although most cases can be managed through a conventional cervical approach, some patients require complementary thoracic approaches due to deep mediastinal extension, close relationship with major vessels, or inability to achieve safe transcervical mobilization. We present the case of a 68-year-old male patient with a long-standing history of multinodular goiter who presented with progressive dyspnea, dysphagia, and cervical pressure sensation. Contrast-enhanced computed tomography of the neck and chest demonstrated a giant multinodular goiter with intrathoracic extension into the superior and anterior mediastinum, significant tracheal deviation and airway narrowing, as well as close proximity to major mediastinal vascular structures. Due to the tomographic findings and the high risk of intraoperative complications, total thyroidectomy through a combined cervical and thoracic approach with partial median sternotomy was performed. Complete resection of the lesion was achieved with adequate preservation of the recurrent laryngeal nerves and parathyroid glands, without major intraoperative complications. Postoperative evolution was satisfactory, with significant clinical improvement of compressive symptoms. Histopathological examination revealed adenomatous multinodular goiter without evidence of malignancy. Surgical management of intrathoracic goiter should be individualized according to anatomical extension and imaging findings, with computed tomography playing a fundamental role in preoperative planning and selection of the most appropriate surgical approach. The thoracic approach remains a safe and effective option in selected patients with complex intrathoracic goiters.