Intra-Thoracic Goitre with Life Threatening Complications: A Continuing Diagnostic Problem

thoracic goitre is very rare. Lahey in 1945 defined intra-thoracic goitre as those in which the greatest diameter of the intra-thoracic mass is below the upper aperture of the thoracic cage, and in which spontaneous reduction into the neck does not occur. Hoffman (1955) considered the incidence of true intra-thoracic goitre to be in the order of 0.2-3% of patients with thyroid enlargement. If we include other cases which do not fulfil the above criterion, the frequency among goitre patients is as high as 21% according to Higgins (1927), McCort (1949), Ellis, Good and Seybold (1952), Sherman and Shahbahrami (1966), Tala and Maamies (1967), Geor9'adis, Katsas and Leoutsakos (1970) and Lesavoy, Norberg and Kaplan (1975). It is generally accepted that intra-thoracic goitre is a mediastinal extension of a thyroid gland which develops in the neck and then descends and enlarges. Very few cases of frank ectopic thyroid in the Mediastinum, with no connection with the thyroid 9land in the neck, have been reported (Doundas, 1964). This study is of 14 patients with true intra-thoracic goitre admitted to the service of one surgeon in the Thoracic Department at Frenchay Hospital in the years 1970 to 1982. There were 8 men and 6 women, and the ages of these patients ranged from 48 to 79 years, with an average of 60.7 years. All patients had been previously seen by physicians or other surgeons, and some presented important diagnostic difficulties. The tumour in all 14 cases was lying in the upper or anterior mediastinum. In 8 patients (6 men and 2 women), the tumour originated from the right lobe of the thyroid and lay in the right anterior mediastinum, in 5 patients (3 women and 2 men) it was in the left anterior mediastinum originating from the left lobe of the thyroid gland, and in one female patient the tumour originated from the left lobe of the thyroid gland but extended posteriorly into the right anterior mediastinum. The weight of the removed tumours varied from 100 to 420 g. and the size from 3><6><4cm to 14x 10><6cm. In 11 of these patients the greatest diameter of the tumour was below the thoracic inlet and in 3 it was at the thoracic inlet.