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Most goiters that extend into the chest can be removed by standard thyroid surgery procedures

(July 2002)

The background of the study. A substernal goiter refers to the presence of a substantial amount of thyroid tissue in the chest. This study summarizes the findings in all patients found to have substernal thyroid disease at the time of surgery at a single hospital from 1990 to 2000.

How the study was done. During the study period 381 patients underwent thyroidectomy, of whom 116 (30 percent) had substernal thyroid disease. There were 95 women and 21 men, with a mean age of 52 years.

The results of the study. The indications for surgery were symptoms or signs of compression of one or more neck structures, including the trachea, esophagus, and neck veins; an abnormal thyroid biopsy; thyroid enlargement; and hyperthyroidism. Thyroid tissue was resected through a standard collar incision in the neck in 114 patients and chest surgery in 2 patients, in whom all thyroid tissue was behind the sternum. The pathologic diagnoses were thyroid carcinoma in 22 patients (19 percent) and benign thyroid disease in 94 patients (81 percent).

The conclusions of the study. Thyroid tissue that extends from the neck into the chest can nearly always be removed by standard thyroid operative procedures.

The original article. Hedayati N, McHenry CR. The clinical presentation and operative management of nodular and diffuse substernal thyroid disease. Am Surg 2002;68:245-51.