C Ron Cannon1, Robert Lee, Ralph Didlake. 1. Head and Neck Surgical Group, 1038 River Oaks Drive, Flowood, Mississippi 39236, USA. crcannonhn@bellsouth.net
Abstract
OBJECTIVES: Review the diagnosis and management of patients with substernal goiter. STUDY DESIGN: Retrospective study of a series of patients treated for substernal goiter. METHODS: Retrospective chart review of patients with substernal goiter (N=16). Records were tabulated for demographics, symptoms, physical and CT findings as well as surgical management and comorbidities. RESULTS: Substernal goiter occurs infrequently. Of the seventeen surgical procedures performed in these sixteen patients, only three required a median sternotomy. All of the patients had multinodular goiter. There were no instances of well differentiated thyroid cancer in this series. Co-morbidities were present in each patient. CONCLUSIONS: Substernal goiters are often quite large at the time of diagnosis as they enlarge slowly. The majority of patients can be managed with a cervical approach. Technological advancements such as the nerve integrity monitor (NIM-2; Medtronic Xomed, Jacksonville, Florida) and Harmonic scalpel as well as team approach to surgery are advantageous for the patient.
OBJECTIVES: Review the diagnosis and management of patients with substernal goiter. STUDY DESIGN: Retrospective study of a series of patients treated for substernal goiter. METHODS: Retrospective chart review of patients with substernal goiter (N=16). Records were tabulated for demographics, symptoms, physical and CT findings as well as surgical management and comorbidities. RESULTS:Substernal goiter occurs infrequently. Of the seventeen surgical procedures performed in these sixteen patients, only three required a median sternotomy. All of the patients had multinodular goiter. There were no instances of well differentiated thyroid cancer in this series. Co-morbidities were present in each patient. CONCLUSIONS:Substernal goiters are often quite large at the time of diagnosis as they enlarge slowly. The majority of patients can be managed with a cervical approach. Technological advancements such as the nerve integrity monitor (NIM-2; Medtronic Xomed, Jacksonville, Florida) and Harmonic scalpel as well as team approach to surgery are advantageous for the patient.