Surgical treatment of substernal goiter: an analysis of 59 patients

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.

Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00595-007-3659-5Authors
Ayman Agha, University of Regensburg Medical Center Department of Surgery Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyGabriel Glockzin, University of Regensburg Medical Center Department of Surgery Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyNabil Ghali, University of Regensburg Medical Center Department of Surgery Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyIgors Iesalnieks, University of Regensburg Medical Center Department of Surgery Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyHans J. Schlitt, University of Regensburg Medical Center Department of Surgery Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany

Journal Surgery TodayOnline ISSN 1436-2813Print ISSN 0941-1291

Journal Volume Volume 38

Journal Issue Volume 38, Number 6 / June, 2008 (Source: Surgery Today)