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Thyroid, Substernal Goiter: Workup

Author: Steven K Dankle, MD, Clinical Associate Professor, Department of Otolaryngology, Medical College of Wisconsin
Contributor Information and Disclosures

Updated: Sep 2, 2009

Workup

Laboratory Studies

  • All patients require thyroid function studies to assess for hyperthyroidism.
  • Consider a preoperative serum calcium study.

Imaging Studies

  • CT scanning or MRI: CT scanning and MRI generally are the most useful and important diagnostic and preoperative imaging studies because they allow for a fairly detailed assessment of the relevant anatomy, including surrounding tissue planes. CT scanning with iodinated contrast media should generally be avoided to preclude triggering of thyrotoxicity. However, if CT scanning with contrast is performed, it should follow thyroid scanning because nuclear imaging is not possible for several weeks after this iodine load.
  • Chest radiography
    • These images often are quite useful because they can reveal the presence of tracheal deviation or compression.
    • Chest radiography sometimes provides the first evidence of a mediastinal mass.
  • Barium esophagraphy: Barium esophagraphy is often obtained in the evaluation of dysphagia because it may demonstrate extrinsic compression or deviation. Barium esophagraphy is often not particularly helpful in the preoperative assessment of known substernal goiter.
  • Nuclear thyroid imaging and sonography
    • Nuclear thyroid imaging may demonstrate thyroid activity in the mediastinum, but the absence of uptake in the mediastinum does not exclude a diagnosis of substernal goiter.
    • Sonography may demonstrate the presence of a mediastinal mass, but it is not as helpful as chest radiography or CT scanning.
    • Neither nuclear imaging nor sonography is necessary in the preoperative assessment of known substernal goiter.

Diagnostic Procedures

Fine-needle aspiration of goiters for cytologic analysis may be helpful when a significant cervical component exists; however, they often are not recommended for substernal goiters because they may be dangerous or impossible to obtain.

More on Thyroid, Substernal Goiter

Overview: Thyroid, Substernal Goiter
Workup: Thyroid, Substernal Goiter
Treatment: Thyroid, Substernal Goiter
Multimedia: Thyroid, Substernal Goiter
References
Further Reading
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References

  1. Shaha AR. Surgery for benign thyroid disease causing tracheoesophageal compression. Otolaryngol Clin North Am. Jun 1990;23(3):391-401. [Medline].

  2. Neves MC, Rosano M, Hojaij FC, Abrahao M, Cervantes O, Andreoni DM. A critical analysis of 33 patients with substernal goiter surgically treated by neck incision. Braz J Otorhinolaryngol. Mar-Apr 2009;75(2):172-6. [Medline].

  3. Cohen JP, Cho HT. Surgery for substernal goiters. In: Operative Techniques in Otolaryngology - Head and Neck Surgery. Vol 5. 2nd ed. Philadelphia, Pa:. WB Saunders Co;1994:118-125.

  4. Fritts L, Thompson NW. The surgical treatment of substernal goiter. In: Operative Techniques in Otolaryngology - Head and Neck Surgery. Vol 5. 3rd ed. Philadelphia, Pa:. WB Saunders Co;1994:179-188.

  5. Mack E. Management of patients with substernal goiters. Surg Clin North Am. Jun 1995;75(3):377-94. [Medline].

  6. Netterville JL, Coleman SC, Smith JC. Management of substernal goiter. Laryngoscope. Nov 1998;108(11 Pt 1):1611-7. [Medline].

  7. Singh B, Lucente FE, Shaha AR. Substernal goiter: a clinical review. Am J Otolaryngol. Nov-Dec 1994;15(6):409-16. [Medline].

  8. Torre G, Borgonovo G, Amato A. Surgical management of substernal goiter: analysis of 237 patients. Am Surg. Sep 1995;61(9):826-31. [Medline].

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Keywords

goiter, thyroid, substernal thyroid goiter, mediastinal mass, thyroid mass, substernal thyroid masses, substernal goiters, thyroidectomy, cervical goiter, hyperthyroidism, thyrotoxicity

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Contributor Information and Disclosures

Author

Steven K Dankle, MD, Clinical Associate Professor, Department of Otolaryngology, Medical College of Wisconsin
Steven K Dankle, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and State Medical Society of Wisconsin
Disclosure: Nothing to disclose.

Medical Editor

David J Terris, MD, FACS, Porubsky Professor and Chairman, Department of Otolaryngology, Medical College of Georgia
David J Terris, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Association for the Advancement of Science, American Bronchoesophagological Association, American College of Surgeons, American Head and Neck Society, Federation of American Societies for Experimental Biology, International Association of Endocrine Surgeons, Phi Beta Kappa, Radiation Research Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Erik Kass, MD, Chief, Department of Clinical Otolaryngology, Associates in Otolaryngology of Northern Virginia
Erik Kass, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Association for Cancer Research, American Medical Association, and American Rhinologic Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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