Total Thyroidectomy for Substernal Goiter

Abstract

Removal of the thyroid for symptomatic goiters has been the treatment of choice for enlarging thyroid glands that result in compression with shortness of breath, dysphagia or dysphonia. Other symptoms may include a globus sensation and undesirable cosmetic appearance due to growth. There may be enlarged nodules that have suspicious features for cancer or cannot be appropriately assessed with ultrasound and fine needle aspiration (FNA) biopsy of the nodules. In patients with large substernal components, provocative maneuvers such as raising of the arms can lead to compression of the thoracic inlet and venous drainage eponymously known as Pemberton’s sign leading to facial congestion and plethora (Hamidi et al., 2018). Although new technologies such as radiofrequency ablation may help with controlling the size of large goiters, the tissue cannot be examined after treatment and substernal components may be difficult to address (Haugen et al., 2016). Radioactive iodine treatment can also be used to arrest growth or shrink goiters, but the initial phase of treatment may cause swelling of the gland increasing symptoms and the overall decline in size averages about 20% of the gland size which may not be sufficient treatment for diffusely enlarged goiters.