The presence of
substernal goiter is, per se, an indication for surgical management. Surgical approach of
substernal goiter can most commonly be performed using the cervical access, but at times, a
sternotomy or
thoracotomy is necessary. The aim of this study was to identify the preoperative predictors of a
sternotomy in the management of
substernal goiter in order to provide better preoperative planning and patient consent. Between 2005 and 2012, 665 patients were referred to our clinic for
thyroidectomy, 42 patients (6.3%) had
substernal goiter and were included in this study. All
substernal goiters were treated surgically, 38 (90.5%) by a cervical approach and 4 (9.5%) by full
median sternotomy. All surgeries were successful, with no major postoperative complications. Minor postoperative complications of transient
hypocalcemia and transient
paralysis of the recurrent laryngeal nerve occurred in 5 (11.9%) and 2 (4.7%) cases, respectively. Indication of
median sternotomy was as follows: extension of
goiter below the aortic arch, large thyroid tissue extending towards tracheal bifurcation, and
ectopic thyroid tissue in the mediastinum.
Substernal goiter can be removed through a cervical incision, but on rare occasions, a
median sternotomy may be required.