[Substernal goiter: a diagnostic and therapeutic problem. (Report of 39 surgically treated cases)]

Substernal goiter is a rare pathology and its definition varied from author to author. We considered substernal the goiter that has the larger diameter below the thoracic inlet, in accord to definition of Valdoni (1957). The authors examined retrospectively 40 cases of endothoracic goiter, that represent 6.1% of patients operated on thyroid. Surgical access was in 35 cases a cervical collar incision; in 2 patients was necessary to associate a median superior sternotomy and in another patient a lateral thoracotomy. In 3 patients the access was a median sternotomy and in the last patient a posterolaterally thoracotomy. The authors carried out 12 total thyroidectomy (30.7%), 15 subtotal thyroidectomy (38.6%), 10 total lobectomy (25.6%), 2 subtotal lobectomy (5.1%). No mortality was observed. The morbility was represented by 5 monolateral temporary palsy of recurrent laringeal nerve, 6 transitory hypocalcemia, 1 tetanic syndrome, 1 transitory arrhythmy. The follow-up was managed on 35 patients (89.7%). We observed 1 definitive hypoparathyroidism, 1 paralysis of recurrent laringeal nerve, 1 mediastinic relapse. One patient was operated on total thyroidectomy 14 years after the first surgery for a differentiated carcinoma. In conclusion the treatment of substernal goiter is surgical. Debating point is the entity of exeresis. We think that the first choice operation is thyroidectomy, done through a cervical collar incision. Occasionally sternotomy or thoractomy are necessary.