Substernal Thyroid Goiter Workup

  • Author: Steven K Dankle, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Apr 13, 2012
 

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.

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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.

Specialty Editor Board

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.

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

Disclosure: Medscape Salary Employment

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.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, 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 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, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

References

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  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. Oct 2011;33(10):1420-5. [Medline].

  3. 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. Oct 25 2011;17(5):524-7. [Medline].

  4. 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].

  5. 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.

  6. 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.

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

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

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

  10. 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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Patient with a goiter. Prominent side-view outline.
 
 
 
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