Which of the following findings in a patient with a retrosternal multinodular goitre is the strongest indication for planning a median sternotomy as part of thyroidectomy?

• A Fine needle aspiration shows a benign colloid nodule
• B Patient has mild compressive dyspnoea when lying flat
• C Goitre extends below the level of the aortic arch on CT ✓
• D Sestamibi scan shows a mediastinal parathyroid adenoma

Explanation

Most retrosternal goitres can be delivered through a standard cervical incision because they are pulled up by their blood supply. Median sternotomy is reserved for goitres extending below the aortic arch, true invasive malignancy involving mediastinal structures, previous thyroid surgery with lost planes causing adhesions, or massive goitres with narrow thoracic inlet. Orthopnoea itself is an operative indication but not specifically for sternotomy, and a benign FNA argues against extended exposure.

Reference: Bailey and Love Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.