The Big-T in the Chest Cavity

Background Substernal goiters present a unique surgical challenge. The reported incidence of substernal goiters ranges from 2% to 19%. Complete resection is the standard treatment. We report a case series managed at our clinic. We aim to contribute to the growing body of literature and provide insights for clinicians managing similar cases.

Methods & Materials Case 1. 58-yo female patient with the history of total thyroidectomy presented with retching, dizziness, dysphagia, and weight loss. A radioiodine scintigraphy detected recurrent retrosternal disease. After unsuccessful radioiodine ablation the resection was performed via median sternotomy, revealing 9 cm goiter.

Case 2. 77-yo patient with history of thyroidectomy was diagnosed with 4 cm retrotracheal tumor during myocardial perfusion PET-stress test. After two inconclusive biopsies with EUS and EBUS, a resection via right sided uniportal-VATS was performed, revealing 6 cm goiter.

Case 3. 62-yo patient was diagnosed with late onset myasthenia gravis. A chest-CT showed 10 cm mass in anterior mediastinum. The resection was performed via median sternotomy, revealing a goiter surrounded by involuted thymic tissue.

Case 4. 44-yo patient without symptoms, discretely pronounced peripheral veins in upper body and right-sided ptosis had an incidental diagnose of 12 cm mass in right hemithorax following traffic accident. The resection was performed through right lateral thoracotomy and revealed an 18 cm goiter with no signs of malignancy.

Results Postoperative course of all patients was uneventful. One patient presented postoperative recurrent nerve palsy. The chest tubes were removed on postoperative day three and patients discharged on the fourth postoperative day. The outpatient visits were unremarkable.

Conclusion Substernal goiters have variable clinical presentation. The choice of surgical approach depends on the tumor size, localization and involvement of the adjacent structures. Early referral to thoracic surgery could shorten the time to treatment and reduce the costs by avoiding unnecessary diagnostic procedures.

Publikationsverlauf

Artikel online veröffentlicht:
25. August 2025