Ernst G. Eising^*, Sandra Rosenbaum-Krumme, Walter Jentzen, Alfred Gödecke, Andreas Bockisch

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Radprax, Arnsberg, Germany.
Clinic for Nuclear Medicine, University of Duisburg-Essen, Duisburg and Essen, Germany.
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Abstract: The diagnosis of a retrosternal thyroid growth (RTG) causes extended surgical exploration and a different surgical treatment planning (partial sternotomy, thoracotomy) and is usually made by the help of thyroid scintigraphy and ultrasonography. But both examinations have problems in determining the retrosternal thyroid extend in the complex anatomy of sternal bone and often pathologically altered manubrioclavicular joints (MCJ). This study evaluates the variation of anatomical structures in the upper sternal region, the position of the sternal markers during scintigraphy, and the frequency of enhanced bone metabolism of the MCJs. For this aim, the positions of the upper edges of the MCJs were measured by X-ray fluoroscopy in 50 consecutive patients. To prove the exactness of an external marker as used in thyroid scintigraphy, the variation of the marker position was also determined. The activity in the MCJs was measured semiquantitatively with bone scintigraphy in further 100 patients (mean age: 62.3 yrs, SD: 14.2 yrs). As results, the upper edges of the medial clavicular edges exceed the upper margin of the sternal edge up to 2.7 cm. The distance between the medial clavicular edges ranged from 2.3 - 5.6 cm. The position of the sternal marker was correct in the horizontal deviation (mean: 0.1 cm, SD: 0.48 cm) but too high in the vertical position (mean: 2.2 cm, SD: 0.67 cm). During bone scintigraphy, the MCJs showed no enhanced activitity in 75/200 joints, medium activity in 96/200 joints, and strong enhanced activity in 29/200 joints. In consequence, a high variability in the position of the anatomical structures has to be considered together with a high amount of degenerative alterations. The position of the sternal marker was inappropriate in the vertical direction and overestimated a possible retrosternal growth.

Keywords: Thyroid Gland; Thyroid Scintigraphy; Manubrioclavicular Joints

Cite this paper: Eising, E. , Rosenbaum-Krumme, S. , Jentzen, W. , Gödecke, A. and Bockisch, A. (2012) Definition of retrosternal thyroid growth. Open Journal of Clinical Diagnostics, 2, 36-39. doi: 10.4236/ojcd.2012.22007.

References

[1]   Ignjatovic, M., Stanic, V., Cuk, V. and Kostic, Z. (2002) Intrathoracic goiter: Analysis of 21 cases. Acta Chirurgica Jugoslavica, 49, 15-25. doi:10.2298/ACI0201015I

[2]   Batori, M., Chatelou, E. and Straniero, A. (2007) Surgical treatment of retrosternal goiter. European Review for Medical and Pharmacological Sciences, 11, 265-268.

[3]   Moron, J.C., Singer, J.A. and Sardi, A. (1998) Retrosternal goiter: A six-year institutional review. The American Surgeon, 64, 889-893.

[4]   Hedayati, N. and McHenry, C.R. (2002) The clinical presentation and operative management of nodular and diffuse substernal thyroid disease. The American Surgeon, 68, 245-252.

[5]   Huins, C.T., Georgalas, C., Mehrzad, H. and Tolley, N.S. (2008) A new classification system for retrosternal goitre based on a systematic review of its complications and management. International Journal of Surgery, 6, 71-76. doi:10.1016/j.ijsu.2007.02.003

[6]   Chauhan, A. and Serpell, J.W. (2006) Thyreoidectomy is safe and effective for retrosternal goitre. ANZ Journal of Surgery, 76, 238-242. doi:10.1111/j.1445-2197.2006.03699.x

[7]   Cohen, J.P. (2009) Substernal goiters and sternotomy. Laryngoscope, 119, 683-688. doi:10.1002/lary.20102

[8]   Cui, Y., Zhang, Z., Li, S., Li, L., Zhang, H. and Li, Z. (2002) Diagnosis and surgical management for retrosternal thyroid mass. Chinese Medical Sciences Journal, 17, 173-177.

[9]   Hardy, R.G., Bliss, R.D., Lennard, T.W., Balasubramanian, S.P. and Harrison, B.J. (2009) Management of retrosternal goitres. Annals of the Royal College of Surgeons of England, 91, 8-11. doi:10.1308/003588409X359196

[10]   Hsu, B., Reeve, T.S., Guinea, A.I., Robinson, B. and Delbridge, L. (1996) Recurrent substernal nodular goiter: Incidence and management. Surgery, 120, 1072-1075. doi:10.1016/S0039-6060(96)80057-2

[11]   Alifano, M., Parri, S.N., Arab, W.A., Bonfanti, B., Lacava, N., Porello, C. and Boaron, M. (2008) Limited upper sternotomy in general thoracic surgery. Surgery Today, 38, 300-304. doi:10.1007/s00595-007-3626-1

[12]   Shpitzer, T., Saute, M., Gilat, H., Rayeh, E., Koren, I., Shvero, J., Bahar, G. and Feinmesser, R. (2007) Adaptation of median partial sternotomy in head and neck surgery. The American Surgeon, 73, 1275-1278.

[13]   Topcu, S., Liman, S.T., Canturk, Z., Utkan, Z., Canturk, Z., Corak, S. and Cetinarslan, B. (2008) Necessity for additional incisions with the cervical collar incision to remove retrosternal goiters. Surgery Today, 38, 1072-1077. doi:10.1007/s00595-008-3768-9

[14]   Shah, P.J., Bright, T., Singh, S.S., Lang, C.M., Pyragius, M.D., Malycha, P. and Edwards, J.R. (2006) Large retrosternal goitre: A diagnostic and management dilemma. Heart Lung and Circulation, 15, 151-152. doi:10.1016/j.hlc.2005.10.011

[15]   Pfannenstiel, P. and Baew-Christow, T. (1985) Roentgen computer tomography and sonography in thyroid gland diagnosis. Zentralblatt fur Chirurgie, 110, 1105-1114.

[16]   Cooper, J.C., Nakielny, R. and Talbot, C.H. (1991) The use of computed tomography in the evaluation of large multinodular goitres. Annals of the Royal College of Surgeons of England, 73, 32-35.

[17]   Ben Nun, A., Soudack, M. and Best, L.A. (2006) Retrosternal thyroid goiter: 15 years experience. Israel Medical Association Journal, 8, 106-109.

[18]   Arnold, J.E. and Pinsky, S. (1976) Comparison of 99mTc and 123I for thyroid imaging. Journal of Nuclear Medicine, 17, 261-267.

[19]   Aydin, M., Emri, S. and Caner, B. (2000) Tc-99m pertechnetate scintigraphy before and after potassium perchlorate administration for the diagnosis of retrosternal goiter. Clinical Nuclear Medicine, 25, 467-468. doi:10.1097/00003072-200006000-00015

[20]   Varcus, F., Peix, J.L., Berger, N. and Bordos, D. (2002) Thyroid scintigraphy: Its place in preoperative diagnosis of thyroid nodules? Annals of Chirurgie, 127, 685-689. doi:10.1016/S0003-3944(02)00864-7

[21]   Tindall, H., Griffiths, A.P. and Penn, N.D. (1987) Is the current use of thyroid scintigraphy rational? Postgraduate Medical Journal 1987, 63, 869-871. doi:10.1136/pgmj.63.744.869

[22]   Eising, E.G. and Jentzen, W. (2010) Calcification-related absorption in thyroid scintigraphy. Nuklearmedizin, 49, 13-18. doi:10.3413/nukmed-0204