Sutureless Total Thyroidectomy for Substernal Goiter: Amending Versus Unnecessary

Area of Science:

• Endocrinology
• Surgical Oncology
• Thoracic Surgery

Background:

• Substernal goiter involves thyroid enlargement extending into the mediastinum, necessitating careful surgical planning due to proximity to vital intrathoracic structures.
• Preoperative imaging, including multiplanar cross-sectional views of the neck and chest, is crucial for determining the extent of the goiter and planning an extracervical surgical approach.

Purpose of the Study:

• To report a case of substernal goiter managed with a sutureless total thyroidectomy.
• To emphasize the importance of meticulous surgical technique and anatomical awareness for safe thyroidectomy in cases of substernal goiter.

Main Methods:

• A 57-year-old female with a huge goiter presenting with dyspnea and dysphagia underwent neck and chest computed tomography (CT) for detailed anatomical assessment.
• A sutureless total thyroidectomy was performed via a collar incision, avoiding a median sternotomy.
• Key surgical steps included meticulous division of superior thyroid arteries and veins and identification of the Ligament of Berry in relation to the recurrent laryngeal nerve.

Main Results:

• Neck sonography revealed multiple nodules, with CT confirming substernal extension of the left thyroid lobe to the left innominate vein.
• The sutureless total thyroidectomy was successfully completed without complications related to vital intrathoracic structures.
• The procedure demonstrated the feasibility of an extracervical approach for substernal goiter removal.

Conclusions:

• Sutureless total thyroidectomy is a viable and recommended approach for substernal goiter, provided meticulous dissection of vascular structures and careful identification of the recurrent laryngeal nerve are performed.
• The anatomical relationship of the Ligament of Berry to the recurrent laryngeal nerve is a critical consideration for safe thyroid surgery.