Management of substernal and intrathoracic goiters

Area of Science:

• Surgery
• Endocrinology
• Thoracic Medicine

Background:

• Mediastinal goiters can cause severe respiratory issues and sudden death.
• Surgical removal is the only effective treatment for these goiters.
• Historically common, mediastinal goiters are seen less frequently now.

Purpose of the Study:

• To report the experience with managing 70 patients with substernal or intrathoracic goiters.
• To discuss clinical presentation, preoperative evaluation, operative techniques, and outcomes.
• To consider the pathogenesis of intrathoracic goiter extension.

Main Methods:

• Retrospective review of 70 consecutive patients with substernal or intrathoracic goiters.
• Detailed discussion of clinical presentation, preoperative assessment, and surgical techniques.
• Emphasis on the transcervical approach for goiter resection.

Main Results:

• The transcervical approach allowed safe resection of goiters, even those extending to the aortic arch, without sternotomy.
• A multidisciplinary team approach is essential for optimal patient management.
• The incidence of mediastinal goiter may be increasing due to conservative thyroidectomy selection criteria.

Conclusions:

• Surgical management of mediastinal goiters is effective.
• The transcervical approach is a safe and effective method for resection.
• A multidisciplinary approach is crucial for successful outcomes in mediastinal goiter treatment.