Diagnosis and management of substernal goiter at the University of Crete.

The objective of this work was to evaluate the diagnosis and management of patients with substernal goiter (SSG) on the basis of our experience. We conducted a retrospective study of all SSGs within a series of 591 thyroidectomies performed in a tertiary referral center over a period of 14 years, analyzing epidemiological data, diagnostic criteria, and surgical results. There were 37 (6%) patients with descending goiter: 28 women (mean age 57.1 years) and 9 men (mean age 61 years). All 37 patients underwent successful surgical treatment without any major postoperative complications. A postoperative histological examination revealed a 16.6% incidence of malignancy. Despite the size and close proximity to vital organs in the mediastinum, all of the SSGs were managed successfully. A neck approach was used in all except for one patient who was operated on via sternotomy. A thorough preoperative evaluation including computed tomography scan of the neck and mediastinum, and an appropriate surgical technique ensure a positive outcome for most patients with an SSG.