Endocrine Abstracts

JOINT3528

Introduction: A plunging goiter (PG) is any goiter whose lower limit is not palpable in the surgical position. Its diagnosis is first suspected clinically, then confirmed by imaging. It often requires surgical intervention due to associated life-threatening risks.

Objective: To study the epidemiological aspects of PG, the importance of preoperative imaging and to describe the modalities of surgical management.

Patients and Methods: Retrospective study of 15 cases of PG, operated on at the Department of Head and Neck Surgery and Otorhinolaryngology of the Fattouma Bourguiba University Hospital in Monastir over a period of 5 years from 2020 to 2024.

Results: In 5 years,15 cases of PG representing 1.5% of thyroidectomies performed. The average age was 60 years [33 to 79 years]. The sex ratio was 0.22 with a female predominance (86%). The plunging character was noted on clinical examination and confirmed by imaging. The consultation period was 3 years [4 months - 10 years]. The circumstances of discovery were dominated by the fortuitous discovery of an anterior baservical swelling in 100% of cases and the installation of compressive signs in 73% of cases. A family history of thyroid pathology was reported in 5patients (33%) and a personal history of dysthyroidism was noted in 3patients (20%). All our patients had a chest X-ray, a cervical ultrasound and an indirect laryngoscopy preoperatively. Among the 15 X-rays, an opacity Upper mediastinal goiter was objectified in 8 patients (54%), tracheal deviation in 7 patients (46%), and a normal appearance in 46% of cases. Ultrasound detected the plunging character in 6 patients (40% of cases) and the cervicothoracic CT scan confirmed it in 100% of cases. The goiter plunged to the right in 8 cases (54%), to the left in 6 cases (40%) and bilaterally in 1 case. It also revealed an anterosuperior mediastinal development of the goiter in 13 cases (86%), posterior in 2 cases (13%), and a displacement of the esophagotracheal axis in 9 cases (60%). A loboisthmectomy was performed in 4 cases (33%) and a total thyroidectomy in 11 cases (73%) by the exclusive cervical aaproach. The anatomopathological examination revealed11 benign lesions and 4 malignant ones. Postoperative complications included transient hypoparathyroidism in 2 cases, unilateral transient recurrent paresis in 1 case, and subcutaneous hematoma in another case.

Conclusion: Plunging goiters represent a distinct entity in thyroid pathology due to the complexity of their surgical management. The surgical indication, following a multidisciplinary approach, should be considered prior to the onset of compressive complications.