Substernal Goiter: Correlation between Grade and Surgical Approach

Area of Science:

• Endocrinology
• Surgical Oncology
• Radiology

Background:

• Substernal goiter, a thyroid enlargement extending below the thoracic inlet, presents diagnostic and surgical challenges.
• Cross-section imaging CT classification stratifies substernal goiters into three grades based on extension.

Purpose of the Study:

• To evaluate the efficacy of surgical approaches for substernal goiters.
• To assess the incidence of postoperative complications in relation to substernal goiter grade.

Main Methods:

• Retrospective analysis of 60 patients with substernal goiter undergoing thyroid surgery over 15 years.
• Classification of goiter extension using CT imaging (Grade I, II, III).
• Analysis of surgical techniques (total thyroidectomy, subtotal thyroidectomy, lobectomy) and complication rates.

Main Results:

• A cervical approach was sufficient for 96.7% of thyroidectomies; only two Grade III cases required partial sternotomy.
• Grade III substernal goiter was associated with a significantly higher risk of postoperative dysphonia (OR = 14.29, P = 0.03).
• Transient hypoparathyroidism occurred in 33.3% of patients, unrelated to goiter extension.

Conclusions:

• Substernal goiters are generally resectable via a cervical approach with acceptable morbidity.
• Goiter extension, particularly Grade III, is a key predictor of postoperative dysphonia.
• Surgical planning should consider goiter grade to anticipate potential complications and necessary surgical extent.