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Substernal Thyroid Goiter Workup

  • Author: Steven K Dankle, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Dec 11, 2015
 

Laboratory Studies

All patients require thyroid function studies to assess for hyperthyroidism.

Consider a preoperative serum calcium study.

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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.

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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.[4]

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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, Wisconsin Medical Society, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Medical Association, American Association for Cancer Research, American Rhinologic Society

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, 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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

David J Terris, MD, FACS Porubsky Professor and Chairman, Department of Otolaryngology, Medical College of Georgia, Georgia Regents University

David J Terris, MD, FACS is a member of the following medical societies: American Association for the Advancement of Science, Federation of American Societies for Experimental Biology, International Association of Endocrine Surgeons, Alpha Omega Alpha, Triological Society, Radiation Research Society, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Surgeons, American Head and Neck Society, Phi Beta Kappa, Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

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

  2. Raffaelli M, De Crea C, Ronti S, Bellantone R, Lombardi CP. Substernal goiters: incidence, surgical approach, and complications in a tertiary care referral center. Head Neck. 2011 Oct. 33(10):1420-5. [Medline].

  3. Tunc M, Sazak H, Karlilar B, Ulus F, Tastepe I. Coexistence of Obstructive Sleep Apnea and Superior Vena Cava Syndromes Due to Substernal Goitre in a Patient With Respiratory Failure: A Case Report. Iran Red Crescent Med J. 2015 May. 17 (5):e18342. [Medline].

  4. Kumar A, Mohan A, Dhillon SS, Harris K. Substernal thyroid biopsy using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration. J Vis Exp. 2014 Nov 10. e51867. [Medline].

  5. Wexler S, Yamane K, Fisher KW, Diehl JT, Hirose H. Single-stage operation for giant substernal goiter with severe coronary artery disease. Ann Thorac Cardiovasc Surg. 2011 Oct 25. 17(5):524-7. [Medline].

  6. Heineman TE, Kadkade P, Kutler DI, Cohen MA, Kuhel WI. Parathyroid Localization and Preservation during Transcervical Resection of Substernal Thyroid Glands. Otolaryngol Head Neck Surg. 2015 Jun. 152 (6):1024-8. [Medline].

  7. Nankee L, Chen H, Schneider DF, Sippel RS, Elfenbein DM. Substernal goiter: when is a sternotomy required?. J Surg Res. 2015 Apr 18. [Medline].

  8. Rolighed L, Rønning H, Christiansen P. Sternotomy for substernal goiter: retrospective study of 52 operations. Langenbecks Arch Surg. 2015 Apr. 400 (3):301-6. [Medline].

  9. 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. 2009 Mar-Apr. 75(2):172-6. [Medline].

  10. 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.

  11. 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.

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

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

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

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

 
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Patient with a goiter. Prominent side-view outline.
 
 
 
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