Yutma Güçlüğü ve Beslenme Yetersizliğine Neden Olan Retrosternal Guatr

Tiroid dokusunun anormal büyümesi olarak tanımlanan guatr terimi, klinik pratikte oldukça sık görülen bir sorundur. Retrosternal guatr ise, torasik giriş düzleminin altına uzanan veya kütlesinin %50'sinden fazlasının sternal çentiğin altında yer aldığı guatrlar olarak tanımlanmaktadır. Bizde olgumuzda retrosternal guatrı olan hastada servikal insizyonun yanında sternotomi gereksinimi olan olguyu sunmayı amaçladık. 82 yaşında erkek hasta son 1 yıldır olan fakat son 3 aydır neredeyse tamamen beslenememe şikâyeti nedeni ile gastroenteroloji kliniğine başvurmuş, hastaya yapılan özofagogastroskopide darlık saptanması üzerine iki kez dilatasyon yapılmış, fakat hastanın semptom ve kilo kaybı sebat etmesi üzerine kliniğimize başvurdu. Yapılan tiroid ultrasonu ve toraks tomografinde retrosternal guatr saptanan hastaya göğüs cerrrahisi ile birlikte servikal-torasik yaklaşım ile bilateral total tiroidektomi yapıldı. Postoperatif dönemde sorun yaşanmayan hasta şifa ile taburcu edildi. Sonuç olarak yutma güçlüğü ve trakeal bası semptomları olan hastada retrosternal guatr akılda tutulmalı ve preoperatif dönemde radyolojik görüntüleme yöntemleri kullanılarak yapılacak cerrahi yöntemi dikkatlice seçilmelidir.

Anahtar Kelimeler:

yutma güçlüğü, retrosternal guatr, tiroid, difficulty swallowing, retrosternal goiter, thyroid

A Case of Retrosternal Goiter Which Causes Dysphagia and Nutritional Deficiency

The term goiter, defined as an abnormal growth of thyroid tissue, is a widespread problem in clinical practice. Retrosternal goiter is defined as goiter extending below the thoracic inlet plane or in which more than 50% of its mass is below the sternal notch. In our case, we aimed to present a patient with a retrosternal goiter who needed sternotomy besides cervical incision. An 82-year-old male patient was admitted to the gastroenterology clinic with complaints of dysphagia lasting for one year and inability to eat almost entirely, which started three months ago. When stenosis was detected in the esophagogastroscopy, dilatation was performed twice, but the patient's symptoms and weight loss continued. With these complaints, the patient was diagnosed with retrosternal goiter by thyroid ultrasound and thoracic tomography imaging. Bilateral total thyroidectomy was performed with a cervical-thoracic approach together with thoracic surgeons. There was no problem in the postoperative period, and the patient was discharged with recovery. As a result, retrosternal goiter should be kept in mind in patients with dysphagia and tracheal compression symptoms. In addition, the surgical method should be carefully selected using radiological imaging methods in the preoperative period.

Keywords:

difficulty swallowing, retrosternal goiter, thyroid,

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