The Surgical Treatment of Retrotracheal Intrathoracic Goiter

Numerous surgical procedures have been suggested for the proper management of thyroid masses which migrate into or occur ectopically in areas removed from their usual anatomical location in front of the trachea. It is generally accepted that subclavicular and substernal extensions of moderate size are easily and properly delivered through the conventional cervical incision. Unusually large masses, if soft, can be reduced in size before delivery by the morcellation technique of Lahey.¹ Substernal extensions, however, which have migrated far inferiorly or are too solid to allow intracapsular "gouging" are best removed by using a combined cervical and median sternotomy approach.²

That thyroid tumors can occur ectopically is suggested by authentic reports of intratracheal, aortic, pericardial, and intracardiac accessory thyroid masses.* Some of these ectopic tumors have been encountered deep in the thorax above the diaphragm or in the posterior mediastinum behind the esophagus far removed from the cervical