The word goitre (or goiter) is derived from the latin word guttur, meaning throat, and is generally referred to as an enlargement of the thyroid gland.
Sub-sternal goitre : there is no clear definition, but recently, it has been considered as a goiter that requieres mediastinal exploration and dissecation for removal or when the intrathoracic component appears to extend more than 3 cm from the thoracic inlet1.
Most anterior substernal thyroid goiters are accessed via a transcervical approach. For goiters that cannot be removed via neck dissection, such as those goiters with complicated anatomic extensions or posterior mediastinal involvement, the surgeon may need to incorporate a partial upper sternotomy and clavicular head resection or minithoracotomy for adequate exposure.
According to one study
"The most significant criteria for selecting patients requiring sternotomy are computed tomography features, in particular the presence of an ectopic goitre, the thyroid gland volume and the extent of the goitre to or below the tracheal carina"3
A potential pitfall while assessing for retrosternal extension is the apparent l lower position the gland temporarily assumes if imaging is done on a chest CT protocol with arms raised. This can be avoided by having the patient's arms by his/her sides while imaging for retrosternal extension 2. A surgeon who follows a radiologic interpretation of a substernal thyroid goiter given from a dedicated chest CT technique might perform a sternotomy instead of a simple low-collar incision for resection of a substernal goiter.
- 1- Terris D, Gourin C. Thyroid and Parathyroid Diseases, Medical and Surgical Management. Thieme Medical Pub. (2008) ISBN:1588905187. Read it at Google Books - Find it at Amazon
- 2- Pollard DB, Weber CW, Hudgins PA. Preoperative imaging of thyroid goiter: how imaging technique can influence anatomic appearance and create a potential for inaccurate interpretation. AJNR Am J Neuroradiol. 2005;26 (5): 1215-7. AJNR Am J Neuroradiol (citation) - Pubmed citation
- 3- Rugiu MG, Piemonte M. Surgical approach to retrosternal goitre: do we still need sternotomy? Acta Otorhinolaryngol Ital. 2009;29 (6): 331-8. - Free text at pubmed - Pubmed citation
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