title: Substernal goiter: a clinical review.
abstract: Thyroid disease is a very common problem, but indications for surgery are few. We have seen a large number of patients with multinodular goiter. The main indications for surgery in thyroid disease include fear of malignancy, tracheo-esophageal compression, and cosmetic reasons. Tracheo-esophageal compression is most commonly noted in patients with mediastinal goiters. Substernal goiter is defined as those situations in which at least 50% of the gland is in the mediastinal location. Although its incidence has decreased, it remains prevalent in almost every country in the world today. SSG is best diagnosed by a thorough history and physical examination, complemented by airway films, fiberoptic laryngoscopy, and computerized tomography. The most common presenting symptoms are those produced secondary to compression effects. SSG show a poor response to medical treatment. Moreover, given their propensity to cause acute airway symptoms, surgical treatment should be considered in most cases. Extirpation of the gland is best performed through a collar incision, with the addition of a median sternotomy in select few and difficult cases. Median sternotomy is necessary in only 1% to 2% of cases. Operative mortality is negligible, and the incidence of complication is minimized by following strict surgical principles.
authors.affiliation: Department of Otolaryngology, State University of New York, Health Science Center at Brooklyn.
authors.forename: B
authors.initials: B
authors.lastname: Singh
authors.forename: F E
authors.initials: FE
authors.lastname: Lucente
authors.forename: A R
authors.initials: AR
authors.lastname: Shaha
mesh_terms: D003952:Diagnostic Imaging; D006045:Goiter, Substernal / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology; D013965:Thyroidectomy / Q000379:methods