Management of the substernal goiter: a team approach

Review the diagnosis and management of patients with substernal goiter.

Retrospective study of a series of patients treated for substernal goiter.

Retrospective chart review of patients with substernal goiter (N=16). Records were tabulated for demographics, symptoms, physical and CT findings as well as surgical management and comorbidities.

Substernal goiter occurs infrequently. Of the seventeen surgical procedures performed in these sixteen patients, only three required a median sternotomy. All of the patients had multinodular goiter. There were no instances of well differentiated thyroid cancer in this series. Co-morbidities were present in each patient.

Substernal goiters are often quite large at the time of diagnosis as they enlarge slowly. The majority of patients can be managed with a cervical approach. Technological advancements such as the nerve integrity monitor (NIM-2; Medtronic Xomed, Jacksonville, Florida) and Harmonic scalpel as well as team approach to surgery are advantageous for the patient.