The surgical treatment of substernal goiter

Abstract

Substernal goiter remains a common consideration in the differential diagnosis of a mediastinal mass. Given the potential for serious goiter-related complications as well as the inability to rule out associated malignancy, it has been our policy to treat all substernal goiters surgically over the past 20 years. During the period from 1972 to 1992, 101 patients with the major component of their goiters below the thoracic inlet underwent thyroidectomy. The most common symptoms were related to airway compression (82%) and dysphagia (37%). In addition, there was a 13% incidence of malignancy and a similar occurrence of thyrotoxicosis in this group of patients. Although total thyroidectomy was performed only for malignant goiters during the first decade, 71% of patients had total thyroidectomies during the second and, with a few exceptions, all procedures were done through a cervical incision. No patient developed permanent hypoparathyroidism, although two developed permanent unilateral vocal cord palsies. Surgical treatment is a safe procedure with rare mortality (none in this series) and low morbidity. Total thyroidectomy was not associated with added morbidity and it eliminates the possibility of recurrent goiter.