Surgical management of substernal goitres at a tertiary referral centre: A retrospective cohort study of 2,104 patients

Abstract

Chest radiography and thyroid sonography may provide initial radiologic evidence of goitre extension into the superior mediastinum. Computed tomography evaluation of the depth of goitre extension to the tracheal bifurcation was the strongest predictor of the need to use a thoracic approach. There were no significant differences in the clinical features and outcomes of patients with right- and left-sided substernal goitres. The right recurrent laryngeal nerve shows increased susceptibility to damage during thyroid surgery for substernal goitres. The incidence of malignant substernal goitres is similar to that of malignant cervical goitres.

Ultrasound‐Guided Percutaneous Microwave Ablation for Substernal Goiter: Initial Experience

“…However, during MWA, only local anesthesia was administered to alleviate pain in the patients; therefore, it was unnecessary to have concern about anesthesia complications. Third, after thyroidectomy, the incidence rates of hypoparathyroidism and hypocalcemia caused by injury of the parathyroid are as high as 15.0% and 7.6% respectively . However, in our study, injury of the parathyroid and other vital structures did not occur.…”

“…Third, after thyroidectomy, the incidence rates of hypoparathyroidism and hypocalcemia caused by injury of the parathyroid are as high as 15.0% and 7.6% respectively. 7,27 However, in our study, injury of the parathyroid and other vital structures did not occur. The good result, in our opinion, can be explained by the minor invasion of MWA and substantial experience of the operators.…”

Retrosternal goitre: the role of the thoracic surgeon

“…Most patients tend to have normal thyroid function, although there have been cases of hyper-or hypothyroidism, which can be detected on the basis of laboratory testing, including blood tests (1,5). Recently, a retrospective study examining 140 patients with retrosternal goitre revealed 112 (80%) euthyroid patients, while only 28 (20%) exhibited hyperthyroidism (6). Similarly, about the same percentage of hyperthyroidism (18.5%) was noticed in another cohort of patients diagnosed with intrathoracic goitre, while the rest had normal thyroid function (7).…”

A Large Substernal Goiter that Extended to Both Sides of the Thorax

“…Substernal goiters are found in 5.1–15.7% of patients who undergo thyroid surgery [ 1 , 2 , 5 – 9 ]. Various definitions of substernal goiter have been reported, for example, goiters in which >50% of the lesion is located in the thorax [ 3 , 4 ], those in which any part of the lesion extends below the thoracic inlet [ 1 , 2 , 5 ] and those that extend ≥3 cm below the sternal notch or extend below the fourth thoracic vertebra [ 10 , 11 ]. Estimates of the frequency of substernal goiters vary because of the differences in these definitions.…”

“…Substernal goiters are occasionally encountered in patients with thyroid disease. The incidence of substernal goiters among patients with thyroid goiters is reported to range from 5.1 to 15.7% [ 1 , 2 ]. There are various reported definitions of the condition, and the most commonly accepted definition is as follows: when >50% of the volume of a goiter extends below the thoracic inlet [ 3 , 4 ].…”