Plunging Goiter Made Evident by Valsalva's Maneuver

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Abstract
Extension of a cervical goiter to just beneath the sternum has been variously reported as occurring in 7%,1 12%,2 and 21%3 of all goiters operated on. Since minor substernal extension does not significantly modify the surgical attack, Wakeley and Mulvany1 suggested that the term "intrathoracic goiter" not be applied to this slightly substernal group but rather that the term be reserved for those unique goiters which lie entirely or mostly inferior to the thoracic inlet. Those entirely below the inlet are referred to as being totally intrathoracic. Those mostly below the inlet are called partially intrathoracic. When these more stringent criteria are employed, the incidence of intrathoracic goiter drops to between 1.7%1 and 3%.4 The Lahey thesis3 that the anatomical arrangement of its environs limits anterior spread of an expanding adenomatous goiter but permits inferior spread along a plane to the midiastinum has

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