What is mediastinal thyroid goiter?
Mediastinal thyroid goiter is an encapsulated, lobulated heterogeneous enlargement of part or all of the thyroid gland, most commonly in asymptomatic women with a palpable cervical goiter. Occasionally, local compressive symptoms are present; 20% of lesions extend inferiorly into the thorax, usually into the left anterosuperior mediastinum, and less commonly into the middle or posterior mediastinal compartment. On imaging, a well-defined, lobulated heterogeneous lesion, often in the anterosuperior mediastinum, with areas of cystic, hemorrhagic, or calcific change is seen, often with tracheal displacement in the neck. Tracheal displacement on a chest radiograph indicates a mass of thyroid origin or a goiter. On CT and MRI, identification of contiguity of the mass with the thyroid gland establishes a thyroid origin. Surgical resection is the treatment of choice for symptomatic lesions, although most patients with a goiter are asymptomatic and require no therapy other than iodine or hormonal replacement.