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.
