Surgical treatment of retrosternal goiter

Abstract

Background: The definition of substernal goiter is not uniform and varies among authors. We can define substernal--or retrosternal-goiter a thyroid formation with cervical departure that goes beyond the superior thoracic strait for at least 3 cm and that preserves, generally, the connections between the cervical and thoracic portion, maintaining a direct vascularization supplied by the thyroid arteries. The "forgotten" goiter is an extremely rare disease: a mediastinic thyroid mass found after total thyroidectomy.

Materials and method: 595 patients with thyroid pathology have been treated surgically in our Department. Fifty (8.4%) of these were suffered from a cervico-mediastinic goiter. The diagnosis has been confirmed by the thyroid ecotomography, by the radiologic examination of the chest, by the neck-chest CT examination, by the MR of the mediastinum and by the thyroid scintigraphy.

Discussion: The surgical treatment, in retrosternal goiters, is related to the experiences of surgeons. For the majority of the surgeons almost all antero-superior mediastinal goiters can be removed across a cervicotomy, only in few cases in association with a sternal split. In our experience the cervical approach is the only surgical access used for all the patients. The complication rate following substernal goiter resection is higher than the average rate for cervical thyroidectomy. However, in our series we did not observed permanent recurrential lesions, only in one case a light hypophonia has been observed. After the intervention, in all patients the symptomatology caused by the mediastinal compression has disappeared.