Management of Giant Recurrent Retrosternal Thyroid Goiter in a Low-Volume Surgical Center: A Case Report

Retrosternal goiters may extend beneath the sternum and exert pressure on surrounding structures as they enlarge. Recurrent retrosternal goiters present additional surgical challenges because previous operations can alter normal anatomic planes. We report the case of a 53-year-old woman who presented to our hospital with a gradually enlarging anterior neck mass approximately 16 years after prior cervical surgery. Operative records from the earlier procedure were unavailable, and the nature of the prior surgery could not be determined. She denied stridor, dyspnea, orthopnea, or voice changes. Imaging demonstrated a large multinodular goiter with retrosternal extension to the level of the thoracic inlet, causing tracheal displacement without significant luminal narrowing. Thyroid function was normal, and fine needle aspiration showed benign cytology. The patient underwent total thyroidectomy through a standard cervical collar incision, without the need for sternotomy. Intraoperatively, overlying soft tissue adhesions and scarring were noted. The retrosternal component was removed safely through the cervical approach. The excised specimen weighed approximately 410 g. The right lobe measured 14 × 8.5 cm, the left lobe 8.5 × 3.5 × 4 cm, and the isthmus 2 × 2 cm. Both recurrent laryngeal nerves were preserved, parathyroid function remained intact, and the postoperative course was uncomplicated with complete symptom resolution. Histopathologic examination confirmed benign multinodular hyperplasia with degenerative changes, without evidence of malignancy. This case highlights that even large recurrent retrosternal goiters with limited intrathoracic extension can often be safely managed via a cervical approach, emphasizing the value of careful preoperative assessment and surgical planning.