This report describes the operative experience in 72 patients with
substernal goiters treated over the past 5.5 years. Even though the incidence of multinodular
goiter has decreased in the United States due to the routine use of
iodized salt, we continue to see a large number of patients with massive
goiters, predominantly from Caribbean Islands. The diagnosis of
substernal goiter was made on clinical examination augmented by such radiologic studies, as chest x-ray,
barium esophagograms, airway films, and CT scans. Computed tomographic (CT) scanning was particularly helpful in evaluating the extent of substernal extension. Confirmation of the extent of disease was made at the time of operation. Ninety percent of the patients had tracheal deviation and 85% were symptomatic from airway compression. Esophageal compression was noted in 60% of the patients. All patients had a long history of
goiter with recent onset of pressure symptoms. Flow-volume-loop studies were performed in 44% of the patients and were useful in the evaluation of pressure symptoms. However, the decision for operation was made primarily based on clinical evaluation of signs and symptoms. Sixteen patients in this group were admitted with acute airway distress requiring airway intubation or semi-emergency
decompression. Only 1 patient required mediastinal splitting, while all others were operated by the cervical approach. The decision as to the extent of
thyroidectomy was made at the time of operation. Drains were routinely used because of the large dead space. One patient developed a
hematoma in the recovery room and required re-exploration.(ABSTRACT TRUNCATED AT 250 WORDS)