Tracheoesophageal compression associated with substernal goitre. Correlation of symptoms with cross-sectional imaging findings

Objective: The aim of this study was to compare the subjective tracheoesophageal pressure symptoms associated with substernal goitres with objective cross-sectional radiographic measurements. Design: Patients with substernal goitre were questioned regarding tracheoesophageal compression symptoms and these data were analysed for correlation with radiographic and intra-operative findings. Results: Twenty-six patients were included. Patients with airway symptoms including dyspnoea, stridor and coughing were more likely to have significant tracheal narrowing on pre-operative computed tomography (CT) imaging. There was also a significant correlation between the perceived severity of lump sensation in the throat and the presence of tracheal and oesophageal displacement and retrotracheal extension of the thyroid mass. Conclusion: Pre-operative CT measurements of tracheal and oesophageal displacement, retrotracheal extension and the degree of tracheal compression correlate well with the presence and severity of tracheoesophageal pressure symptoms. None of the radiographic findings that are exclusive to substernal goitre (percentage of substernal mass, goitre size at the level of the thoracic inlet, ratio of goitre size to the vertebral body at the thoracic inlet and retrosternal isthmus size) had any correlation with clinical symptoms in this study.