How is a substernal goiter resected during a thyroidectomy?

Updated: May 08, 2018
  • Author: Neerav Goyal, MD, MPH; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Some patients that present with compressive symptoms and an enlarged thyroid demonstrate substernal extension of their goiter either on physical examination, ultrasound, or CT imaging. The technique and approach for removing these goiters is very similar to a conventional thyroidectomy. Because the goiters originate in the neck, they rarely have a mediastinal blood supply.

Most often, removing substernal goiters does not require a sternotomy; instead, they can be removed by digital dissection along the thyroid capsule. These patients are at an increased risk of recurrent laryngeal nerve injury, with reports as high as 17.5%. Randolph et al found that sternotomy was indicated in patients who had superior vena cava syndrome, a goiter with mediastinal blood supply, a posterior mediastinal goiter, a larger diameter to the intrathoracic component, recurrent substernal goiters, malignancy extending into the mediastinum, or the presence of significant adhesions to mediastinal vessels or pleura. [33]

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