Advertisement

Thyroid

  • Maria Grazia Chiofalo
  • Sergio Venanzio Setola
  • Fabio Sandomenico
  • Orlando Catalano
  • Raffaella D’Anna
  • Paolo Vallone
  • Luciano Pezzullo
Chapter
Part of the Current Clinical Pathology book series (CCPATH)

Abstract

Substernal goiter (SG) is an intrathoracic extension of cervical thyroid tissue. There is no consensus about the definition of substernal goiter, but most of the authors consider intrathoracic, substernal, or mediastinal goiter as any thyroid mass in which 50% of the mass is located below the thoracic inlet. A primary SG goiter is rare.

The reported incidence of SG ranges from 2% to more than 20%. Most of the SGs are located in the anterior mediastinum. Posterior mediastinal goiters account of 10–15% of all SGs. Nearly all posterior SGs occur on the right side since the great vessels prevent the thyroid mass from descending on the left side.

SGs are of clinical significance because of their tendency to progressively enlarge into the mediastinum, with compression of adjacent organs: the trachea, the oesophagus, and the superior vena cava. SG can also produce symptoms of thyrotoxicosis; although the majority of SGs are benign, malignancy occurs in 2–15% of cases. Although in the majority of patients can be treated successfully with minimal morbidity and mortality, in some patients there is an increased operative risk. Surgeons should perform a careful preoperative evaluation to identify such patients and to plan the best surgical approach.

Keywords

Substernal goiter Thyroidectomy Thoracoscopy Sternotomy 

References

  1. 1.
    Newman E, Shaha AR. Substernal goiter. J Surg Oncol. 1995;60(3):207–12.CrossRefPubMedGoogle Scholar
  2. 2.
    Vadasz P, Kotsis L. Surgical aspects of 175 mediastinal goiters. Eur J Cardiothorac Surg. 1998;14(4):393–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Madjar S, Weissberg D. Retrosternal goiter. Chest. 1995;108(1):78–82.CrossRefPubMedGoogle Scholar
  4. 4.
    Shen WT, et al. Predictors of airway complications after thyroidectomy for substernal goiter. Arch Surg. 2004;139(6):656–9; discussion 659–60.CrossRefPubMedGoogle Scholar
  5. 5.
    Nakaya M, et al. Surgical treatment of substernal goiter: an analysis of 44 cases. Auris Nasus Larynx. 2017;44(1):111–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Rui Sheng Y, Chong Xi R. Surgical approach and technique in retrosternal goiter: case report and review of the literature. Ann Med Surg. 2016;5:90–2.CrossRefGoogle Scholar
  7. 7.
    Sanders LE, et al. Mediastinal goiters: the need for an aggressive approach. Arch Surg. 1992;127(5):609–13.CrossRefPubMedGoogle Scholar
  8. 8.
    Erbil Y, et al. Surgical management of substernal goiters: clinical experience of 170 cases. Surg Today. 2004;34(9):732–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Falor WH, Kelly TR, Jackson JB. Intrathoracic goiter. Surg Gynecol Obstet. 1963;117:604–10.PubMedGoogle Scholar
  10. 10.
    Falor WH, Kelly TR, Krabill WS. Intrathoracic goiter. Ann Surg. 1955;142(2):238–47.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Rives JD. Mediastinal aberrant goiter. Ann Surg. 1947;126(5):797–810.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Hall TS, et al. Substernal goiter versus intrathoracic aberrant thyroid: a critical difference. Ann Thorac Surg. 1988;46(6):684–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Salo JA, Dlouhy M, Virtanen I. Congenital cyst and heterotopic pancreatic tissue in the oesophagus. Ann Chir Gynaecol. 1993;82(4):263–5.PubMedGoogle Scholar
  14. 14.
    Lawson W, Biller HF. Management of substernal thyroid disease. In: Falk SA, editor. Thyroid disease. New York: Raven Press; 1990.Google Scholar
  15. 15.
    Randolph GW. Surgery of cervical and substernal goiter. In: Randolph GW, editor. Surgery of the thyroid and parathyroid glands. Philadelphia: Saunders; 2003. p. 70–99.Google Scholar
  16. 16.
    Buckley JA, Stark P. Intrathoracic mediastinal thyroid goiter: imaging manifestations. AJR Am J Roentgenol. 1999;173(2):471–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Hardy RG, et al. Management of retrosternal goitres. Ann R Coll Surg Engl. 2009;91(1):8–11.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Katlic MR, Grillo HC, Wang CA. Substernal goiter. Analysis of 80 patients from Massachusetts General Hospital. Am J Surg. 1985;149(2):283–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Allo MD, Thompson NW. Rationale for the operative management of substernal goiters. Surgery. 1983;94(6):969–77.PubMedGoogle Scholar
  20. 20.
    Miller MR, et al. Upper airway obstruction due to goitre: detection, prevalence and results of surgical management. Q J Med. 1990;74(274):177–88.PubMedGoogle Scholar
  21. 21.
    Hedayati N, McHenry CR. The clinical presentation and operative management of nodular and diffuse substernal thyroid disease. Am Surg. 2002;68(3):245–51; discussion 251–2.PubMedGoogle Scholar
  22. 22.
    White ML, Doherty GM, Gauger PG. Evidence-based surgical management of substernal goiter. World J Surg. 2008;32(7):1285–300.CrossRefPubMedGoogle Scholar
  23. 23.
    Sancho JJ, et al. Increased mortality and morbidity associated with thyroidectomy for intrathoracic goiters reaching the carina tracheae. Arch Surg. 2006;141(1):82–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Qureishi A, et al. Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre? Int J Surg. 2013;11(3):203–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Torres A, et al. Acute respiratory failure and tracheal obstruction in patients with intrathoracic goiter. Crit Care Med. 1983;11(4):265–6.CrossRefPubMedGoogle Scholar
  26. 26.
    de Perrot M, et al. Surgical management of mediastinal goiters: when is a sternotomy required? Thorac Cardiovasc Surg. 2007;55(1):39–43.CrossRefPubMedGoogle Scholar
  27. 27.
    Shin JJ, et al. The surgical management of goiter: part I. Preoperative evaluation. Laryngoscope. 2011;121(1):60–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Sinclair IS. The risk to the recurrent laryngeal nerves in thyroid and parathyroid surgery. J R Coll Surg Edinb. 1994;39(4):253–7.PubMedGoogle Scholar
  29. 29.
    Netterville JL, et al. Management of substernal goiter. Laryngoscope. 1998;108(11 Pt 1):1611–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Rosenthal R, Oertli D. Multinodular and restrosternal goiter. In: Oertli D, Udelsman R, editors. Surgery of the thyroid and parathyroid glands. Berlin: Springer; 2012. p. 121–33.CrossRefGoogle Scholar
  31. 31.
    Tabchouri N, et al. Morbidity of total thyroidectomy for substernal goiter: a series of 70 patients. J Visc Surg. 2018;155(1):11–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Khan MN, et al. Retrosternal goiter: 30-day morbidity and mortality in the transcervical and transthoracic approaches. Otolaryngol Head Neck Surg. 2016;155(4):568–74.CrossRefPubMedGoogle Scholar
  33. 33.
    Pieracci FM, Fahey TJ III. Substernal thyroidectomy is associated with increased morbidity and mortality as compared with conventional cervical thyroidectomy. J Am Coll Surg. 2007;205(1):1–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Maria Grazia Chiofalo
    • 1
  • Sergio Venanzio Setola
    • 2
  • Fabio Sandomenico
    • 2
  • Orlando Catalano
    • 2
  • Raffaella D’Anna
    • 1
  • Paolo Vallone
    • 2
  • Luciano Pezzullo
    • 1
  1. 1.Thyroid Surgery UnitIstituto Nazionale Tumori, IRCCS Fondazione G PascaleNaplesItaly
  2. 2.Radiology UnitIstituto Nazionale Tumori, IRCCS Fondazione G PascaleNaplesItaly

Personalised recommendations