Surgical treatment of a patient with retrosternal thyroid goiter

INTRODUCTION: The term thyroid goiter is accepted worldwide, while the terms "substernal", "retrosternal" or "intrathoracic" are not clearly agreed on. The tendency to enlarge and to compress adjacent anatomical structures and the chance of malignancy impose the surgical excision as the principal treatment option. We present our experience on the management of substernal goiter and through this, a rapid review of the literature.

MATERIALS AND METHODS: The last seventeen years we treated 94 patients with substernal goiter. The mean age was 57 years and the male - female ratio was 1:5. All patients had preoperatory assessment with chest X ray, ultrasound and CT scan of the neck. We performed a total thyroidectomy through cervical access in 96.7% of cases and in 3.2% through sternotomic access.

RESULTS: We found 95.7% cases of anterior and 4.3% cases of posterior goiters, with only one ectopic goiter. Pathologic examination reveal 72.3% colloidocystic goiters, 18% adenomas, 7.4% carcinomas and 2.3% cases of thyroiditis. The most important postoperatory complications were: 2 cases of persistent hypoparathyroidism, 3 cases of recurrent damage and 2 cases of chylothorax. No deaths were observed.

CONCLUSIONS: It is necessary a scientific agreement on the definition of substernal goiter, in order to uniform epidemiological and clinical data. Preoperative assessment is based on chest X ray, ultrasound and CT scan of the neck. Cervicotomic access represents the most frequent approach and total thyroidectomy is the procedure recommended. Postoperative complications are almost the same as for cervical goiters and mortality is nowadays extremely low.