Management of substernal goiter

Area of Science:

• Otolaryngology-Head and Neck Surgery
• Thyroid Surgery
• Radiology

Background:

• Substernal goiters, defined as a significant portion extending into the mediastinum, pose unique surgical challenges.
• Effective management requires careful evaluation of anatomical involvement and surgical approach.

Purpose of the Study:

• To analyze the clinical presentation, radiographic evaluation, and treatment outcomes for patients with large substernal goiters.
• To emphasize the role of imaging in surgical planning and assess treatment results.

Main Methods:

• A retrospective chart review of 150 patients who underwent thyroidectomy.
• Inclusion criteria: substernal goiter (major portion in mediastinum).
• Radiographic studies were reviewed by a neuroradiologist.

Main Results:

• Twenty-three patients (15.3%) had substernal goiters, with a mean age of 59; 78% were female.
• Common symptoms included dyspnea, choking, dysphagia (65%), and hoarseness (43%).
• Radiographs showed tracheal compression (73%) and deviation (77%). Histology revealed multinodular goiter (70%), thyroiditis (13%), and malignancy (17%). All underwent transcervical thyroidectomy without sternotomy; no major complications or tracheomalacia occurred.

Conclusions:

• Transcervical thyroidectomy is a safe and effective approach for large substernal goiters, even with significant mediastinal involvement.
• Preoperative computed tomography scanning is advocated for detailed intraoperative planning.
• No major complications or tracheomalacia were observed despite significant tracheal involvement.