Abstract
Purpose
Substernal goiter is defined as a thyroid mass of which more than 50% is located below the thoracic inlet. In this article we report the diagnosis, symptoms, thyroid function, treatment, and postoperative complications of 59 patients with substernal goiter.
Methods
Between 1992 and 2005, 59 patients underwent surgery for substernal goiter at our institution. The indications for surgery were multinodular goiter in 46 cases, follicular adenoma in two cases, and Hashimoto’s thyroiditis in one case. Ten patients were operated on for recurrent thyroid disease.
Results
The leading preoperative symptoms were dyspnea (49.2%), dysphagia (13.6%), hyperhidrosis (10.2%), and cardiac dysfunction (6.8%). All but two thyroid glands could be removed through a Kocher transverse collar incision. The most common postoperative complications were persistent (5.1%) or temporary (3.4%) paresis of the recurrent laryngeal nerve, transient hypocalcemia (3.4%), and hematoma (3.4%). A tracheotomy was required in one patient with bilateral vocal cord paresis (1.7%).
Conclusions
(1) We conclude that a subtotal thyroidectomy is also the treatment of choice for asymptomatic benign substernal goiter. (2) Transverse collar incision should be the standard approach for most patients. (3) The visual identification of at least two parathyroid glands is essential to prevent permanent postoperative hypoparathyroidism.
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References
Haller A. Disputationes anatomicae selectae. Goettingen: Vandenhoeck; 1749.
Katlic MR, Wang C, Crillo HC. Substernal goiter. Ann Thorac Surg 1985;39:391–399.
Mansberger AR, Weil JP. Surgical embryology and anatomy of the thyroid and parathyroid glands. Surg. Clin North Am 1993;73:727–746.
Van Schil P, Vanmaele R, Ehlinger P, Schoofs E, Goovaerts G. Primary intrathoracic goiter. Acta Chir Belg 1989;89:206–208.
Madjar S, Weisberg D. Restrosternal goiter. Chest 1995;60:207–212.
Singh B, Lucente, FE, Sahara AR. Substernal goiter: a clinical review. Am J Otolaryngol 1994;15:409–416.
Arici C, Dertsiz L, Altunbas H, Demircan A, Emek K. Operative management of substernal goiter: analysis of 52 patients. Int Surg 2001;86:220–224.
Dedivitis RA, Guimaraes AV, Machado PC, Suehara AN, Noda E. Surgical treatment of the substernal goitre. Int Surg 1999;84:190–192.
Erbil Y, Bozbora A, Barbaros U, Özarmagan S, Azezli A, Movalilar S. Surgical management of substernal goiters: clinical experience of 170 cases. Surg Today 2004;34:732–736.
Goudet P, Ragois P, Guergah M, Cougard P. Specific morbidity of substernal goiters. A comparative study with a matched series of cervical goiters (in French). Ann Chir 1996;50:913–917.
Hedayati N, McHenry CR. The clinical presentation and operative management of nodular and diffuse substernal thyroid disease. Am Surg 2002;68:245–251.
Maruotti RA, Zannini P, Viani MP, Voci C, Pezzuoli G. Surgical treatment of substernal goiters. Int Surg 1991;76:12–17.
Netterville JL, Coleman SC, Smith JC, Smith MM, Day TA, Burkey BB. Management of substernal goiter. Laryngoscope 1998;108:1611–1617.
Rodriguez JM, Hernandez Q, Pinero A, Ortiz S, Soria T, Ramirez P, et al. Substernal goiter: clinical experience of 72 cases. Ann Otol Rhinol Laryngol 1999;108:501–504.
Torre G, Borgonovo G, Amato A, Arezzo A, Ansaldo G, De Negri A, et al. Surgical management of substernal goiter: analysis of 237 patients. Am Surg 1995;61:826–831.
Vadasz P, Kotsis L. Surgical aspects of 175 mediastinal goiters. Eur J Cardiothorac Surg 1998;14:393–397.
Mishra A, Agarwal A, Agarwal G, Mishra SK. Total thyroidectomy for benign thyroid disorders in an endemic region. World J Surg 2001;25:307–310.
Parra-Membrives P, Sanchez-Blanco JM, Gomez-Rubio D, Recio-Moyano G, Diaz-Roldan J. Retrosternal goiters: safety of surgical treatment. Int Surg 2003;88:205–210.
Foppiani L, Tancredi M, Ansaldo GL, Ceppa P, Auriati L, Torre GC, et al. Absence of histological malignancy in a patient cohort with follicular lesions on fine-needle aspiration. J Endocrinol Invest 2003;26:29–34.
Bonnema SJ, Knudsen DU, Bertelsen H, Mortensen J, Andersen PB, Bastholt L, et al. Does radioiodine therapy have an equal effect on substernal and cervical goiter volumes? Evaluation by magnetic resonance imaging. Thyroid 2002;12:313–317.
Gaitan E, Nelson NC, Poole GV. Endemic goiter and endemic thyroid disorders. World J Surg 1991;15:205–215.
Kovacs GL, Gonda G, Vadasz G, Ludmany E, Uhrin K, Gorombey Z, et al. Epidemiology of thyroid microcarcinoma found in autopsy series conducted in areas of different iodine intake. Thyroid 2005;15:152–157.
Sarda AK, Kapur MM. Thyroid surgery in an area of iodine deficiency. Head Neck 2005;27:383–389.
Bron LP, O’Brien CJ. Total thyroidectomy for clinically benign disease of the thyroid gland. Br J Surg 2004;91:569–574.
Sand ME, Laws HL, McElvein RB. Substernal and intrathoracic goiter. Reconsideration of surgical approach. Am Surg 1993;49:196–202.
Shaha AR, Jaffe BM. Parathyroid preservation during thyroid surgery. Am J Otolaryngol 1998;19:113–117.
Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 2000;24:1335–1341.
Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 2004;136:1310–1322.
Thomusch O, Sekulla C, Dralle H. Thyroid surgery with intraoperative neuromonitoring of the recurrent laryngeal nerve: a prospective study in Germany with 7617 patients. Br J Surg 2000;87:1276–1277.
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Agha, A., Glockzin, G., Ghali, N. et al. Surgical treatment of substernal goiter: An analysis of 59 patients. Surg Today 38, 505–511 (2008). https://doi.org/10.1007/s00595-007-3659-5
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DOI: https://doi.org/10.1007/s00595-007-3659-5