Goiter is an enlargement of the thyroid gland. There are many goiter causes and many types of goiter that cause the thyroid to enlarge. The growth of the thyroid gland downwards into the rib cage is called substernal goiter or retrosternal goiter. In these patients, the goiter sometimes grows into the mediastinum, which is the space between the lungs.
Although patients with substernal goiter often do not have symptoms, signs of pressure on the esophagus, trachea and chest vessels may occur. A doctor may be consulted with complaints such as difficulty in swallowing, shortness of breath and even palpitation. In some patients, thyroid cancer can also be detected with the picture.
Most of the substernal goiter kits are in the form of benign multinodular goiter. However, sometimes carcinoma may develop in the substernal extension of the same gland. There is a 25% risk of developing malignancy in substernal goiter tables.
Substernal thyroidectomy
In cases of substernal goiter, if there is pressure on the surrounding tissues, if it causes cosmetic defects or if malignancy is suspected, the treatment is surgery. Pressure on surrounding tissues and organs causes emergency surgical treatment.
Asymptomatic patients without respiratory problems can be followed. However, since the risk of malignancy is higher in younger patients, surgical treatment is required.
During the examination, the patient is asked to raise his hands above his head. The Pemberton sign is considered positive if the patient experiences facial flushing, dilation of the neck vessels and even a picture that causes stridor due to compression of the trachea. Surgical treatment is applied in these patients.
Before substernal thyroidectomy, the patient’s thyroid functions are examined. In addition, the surgical method is decided by evaluating the borders of the goiter with computerized tomography and other imaging methods. Thyroid ultrasonography or magnetic resonance imaging may also be used.
Total thyroidectomy is usually performed in these patients to prevent recurrence. The possibility of complications in substernal thyroidectomy operations is higher than in classical cervical thyroidectomy operations. Classic, post-operative complications are to be expected.
It is important to evaluate the comorbidities of patients who underwent substernal thyroidectomy. If necessary, pathological examination can be performed from the tissue taken after surgery. Additional controls, radiotherapy or intervention during surgical operation may be required in patients with malignancy.
Preparations are made for conditions such as permanent hypothyroidism or parathyroidism that may develop after surgery. Some complications such as hoarseness are more common after substernal thyroidectomy surgery. This can also cause permanent hoarseness.