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Substernal Goiter



Related narrative: Substernal Goiter

Substernal goiter is usually due to benign multinodular goiter that extends downward and is fed by the inferior thyroid vessels. Rarely, isolated aberrant thyroid tissue fed by intrathoracic vessels is present in the superior mediastinum. Patients usually present with symptoms of airway and/or esophageal compression. Rarely, superior vena cava syndrome may be present. Up to 20% of patients may have no visible thyroid enlargement in the neck, and the condition may first be seen as tracheal deviation on chest X-ray.

Workup includes thyroid function tests and needle biopsy if indicated. The lesions are usually benign, but a 12-22% malignancy rate is reported. The most useful diagnostic study for anatomic relationships is the CT scan. In the majority ( > 90%) of patients, the goiter extends into the anterior mediastinum.

The great majority (96-98%) of substernal goiters can be resected through a cervical incision. The complication rate for resection is less than 5%. Complications include hypocalcemia, recurrent nerve injury, intrathoracic bleeding, and recurrence in unresected tissue. Parathyroid devascularization is more common during resection of substernal goiter than resection of cervical thyroid, and parathyroid transplantation may be required more frequently to prevent postoperative hypocalcemia.


Townsend: Sabiston Textbook of Surgery, 16th ed., 2001, WB Saunders

Hedayati N, The clinical presentation and operative management of nodular and diffuse substernal thyroid disease, Am Surg 1Mar2002, 68(3)245-51.

Arici C, Int Surg, Operative management of substernal goiter: analysis of 52 patients, Int Surg, 1Oct2001, 86(4): 220-4.

This page was last modified on 11-May-2004.