title: Surgical management of substernal goitre: local experience.
abstract: OBJECTIVE
  To examine the presentation, workup, and surgical complications of substernal goitre.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Regional hospital, Hong Kong.
  
  
  METHODS
  Twenty-four mostly elderly patients (mean age, 60.1 years) who underwent thyroidectomy for substernal goitres between 2000 and 2003 (substernal goitres were defined as those having either a caudal mass transgressing the fourth thoracic vertebra or having more than 50% of their overall mass residing within the thorax).
  
  
  METHODS
  Symptoms, histopathological diagnoses, morbidities, and complications.
  
  
  RESULTS
  Dyspnoea was the most common symptom (n=8, 33%). Three (12.5%) patients presented with acute airway obstruction; however, 13 (54.2%) were asymptomatic apart from the presence of cervical masses. Computed tomographic scans were performed on all but two patients. Malignancy was present in 12.6% of patients, or 16.8% if occult papillary carcinoma is included. Partial or full sternotomies were performed in two (8.3%) patients. Complications included recurrent laryngeal nerve injury (n=1, 2.7% of nerves at risk), transient hypoparathyroidism (n=2, 13.3% of patients at risk), haematoma (n=1, 2.7%), pneumonia (n=1, 2.7%), and wound infection (n=1, 2.7%). There was no operative mortality or permanent hypoparathyroidism. The complication rate was significantly lower in the asymptomatic patients (P=0.033 by Fisher's exact test); clinicopathological parameters were otherwise statistically comparable between the two groups.
  
  
  CONCLUSIONS
  There is rarely any mortality in thyroidectomy for substernal goitre, and the morbidity is also very low, especially in asymptomatic patients. In the absence of contra-indications, substernal goitre should be treated with early surgery rather than having it run the risk of acute airway distress or cancer.
authors.affiliation: Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong.
authors.forename: T L
authors.initials: TL
authors.lastname: Chow
authors.forename: T T F
authors.initials: TT
authors.lastname: Chan
authors.forename: D T K
authors.initials: DT
authors.lastname: Suen
authors.forename: D W
authors.initials: DW
authors.lastname: Chu
authors.forename: S H
authors.initials: SH
authors.lastname: Lam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006045:Goiter, Substernal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013960:Thyroid Function Tests; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome