ORIGINAL ARTICLES   

Minerva Chirurgica 1999 April;54(4):225-30

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: Italian

Substernal goiter. Personal experience

Siragusa G., Gelarda E., Geraci G., Albanese L., Di Pace G.

Background. Personal experience about substernal goiter is reported. Stressing laid on the importance of definition: a goiter that is totally or in the most part below the superior thoracic outlet, with normal vascularization.
Methods. Design: retrospective evaluation of patients observed in the last six years. Setting: General Surgery I, Policlinico, University of Palermo. Subjects: four hundred ninety-six thyroidectomies have been performed, 32 patients (6,5%) were found to have substernal goiters. The age was between 42 and 86 years (middle age 59). Male/female=1/1.9. Asymptomatics were 8 (25%). More frequent symptoms were airway compression (34%), hoarseness (9%), pain (9%), thyrotoxicosis (9%) and dysphagia (3%). Interventions: total thyroidectomies have been always performed. Main outcome measures: the incidence, symptoms, short and long term complication have been valued.
Results. There were no postoperative bleeding or lesion of recurrent nerves or definitive hypoparathyroidism. Postoperative hypocalcemy was observed in 9 patients (28%). Only one temporary hypoparathyroidism (two months) was observed. In 2 patients the histologic examination revealed a papillar carcinoma. There were no intraoperative deaths.
Conclusions. In personal experience the presence of substernal goiter is an indication for total thyroidectomy. The reasons for treating substernal goiter surgically are the following: no effective medical treatment is available; respiratory compromise, thyrotoxicosis, dysphagia, or malignancy can develop in long-standing goiters; surgery, in skilled hands, presents minimal morbility.