Not all thyroids are in the neck. Today we operated on a lady who had a previous left thyroid lobectomy. She came in with a large goiter on the right and some difficulty breathing at night. This is an unusual complaint since most Nigerians I have encountered do not have breathing difficulty, even when they have giant goiters. We removed the left thyroid remnant and then the right goiter but there was a large mass extending into the mediastinum. I could feel the mass between the left carotid, left subclavian and innominate arteries and extending around the aortic arch. With some struggling, I was able to deliver the substernal goiter into the neck and remove it. 

Unfortunately, she bled after the surgery and required a left anterior thoracotomy. There was no blood available, so I scrubbed out of the case and donated, since she was my blood type. I feel like I am in an episode of the Vampire Diaries. We finally controlled the bleeding. We are both anemic now!

Goiter-the substernal component is next to the scalpel

Another episode of the Vampire Diaries