Substernal goiter: analysis of the clinical case

One of the most common pathologies of the thyroid gland is goiter. This is a persistent enlargement of the thyroid parenchyma, more often located in the neck area. However, in rare cases, cervical-substernal goiter occurs, in which the lower poles of the thyroid gland fall below the jugular notch of the sternum into the anterior, or, less often, into the posterior mediastinum. In the structure of morbidity, retrosternal goiter accounts for 30% of all benign neoplasms of the mediastinum, more common in women over 65 years of age. Surgical intervention is the only radical method of treating cervical-substernal goiter. Often, pathologically altered thyroid tissue lies deep in the mediastinum, as a result of which surgical interventions in such patients are operations of particular complexity. Some authors prefer only cervical access during surgical treatment of substernal goiter. However, at present, the need for combined cervicalsternotomy access in patients with retrosternal goiter is increasingly becoming apparent in clinical practice. An important role in choosing this surgical access is played not so much by the size of the cervical-substernal goiter, as by its ratio to the surrounding anatomical formations. In the presented clinical case, patient K., 73 years old, had a tumor in the anterior mediastinum on computed tomography. After a comprehensive examination, a chest goiter was diagnosed, and a multidisciplinary consultation developed treatment tactics. A team of oncological surgeons, together with a cardiovascular surgeon, performed an operation to remove the goiter using a combined cervical-sternotomy approach. After successful separation from the main venous vessel and pericardium, the goiter was successfully resected. The correct choice of operative access and the possibility of integration into the operating team of specialists in related fields of medicine determines the optimal amount of treatment and its long-term results.

1. Agafonov G. M., Gostimskiy A. V., Karpatskiy I. V., Matveyeva Z. S., Agafonova M. K., Muromtseva V. A. Cervical-substernal goiter: an algorithm for diagnosis and choice of surgical treatment tactics. Forcipe. 2021; 4 (3): 11–18 (In Russ.).

2. Gostimskiy A. V., Karpatskiy I. V., Matveyeva Z. S., Shudayev I. R., Selikhanov B. A. Diagnosis and choice of surgical tactics for cervical-substernal goiter. Tavricheskiy mediko-biologicheskiy vestnik = Tauride Medical and Biological Bulletin. 2020; 23 (2): 52–58 (In Russ.).

3. Magomedov M. M., Osmanov O. M. Surgical treatment of substernal goiter. Moskovskiy khirurgicheskiy zhurnal = Moscow Surgical Journal. 2021; 1: 54–58 (In Russ.).

4. Belokonev V. I., Kovaleva Z. V., Pushkin S. Yu., Galstyan N. E., Larina T. V. Indications for the volume of surgery and features of thyroidectomy technique in patients with substernal goiter. Tavricheskiy mediko-biologicheskiy vestnik = Tauride Medical and Biological Bulletin. 2020; 23 (2): 15–19 (In Russ.).

5. Knobel M. An overview of retrosternal goiter. Journal of Endocrinological Investigation. 2021; 44 (4): 679–691.

6. Wang X., Zhou Y., Li C., Cai Y., He T., Sun R., Tian W., Tang Z., Sheng J., Liu D., Gui C., Zeng D., Shui C., Jang J., Zhu G., Ning Y., Wang W. Surgery for retrosternal goiter: cervical approach. Gland Surgery. 2020; 9 (2): 392.

7. Sakr M. F., Sakr M. F. Retrosternal Goiter. Thyroid Disease: Challenges and Debates. 2020: 305–344.

8. Tsurkan A. A., Tsurkan A. Yu. Anatomical and functional changes of the thyroid gland in substernal goiter and the possibility of surgical treatment. Odnoralovskie morfologicheskie chteniya = Peer-to-peer morphological readings. 2022: 325–328 (In Russ.).

9. Gorniak A., Carlson-Dexter P., Ochoa J., Carmichael A. Substernal multinodular goiter resulting in superior vena cava syndrome and tracheal compression. BMJ Case Reports CP. 2023; 16 (3): e252827.

10. Grubnik V. V., Parfentiev R. S., Kosovan V. M., Parfentieva N. D. Modern approaches to the treatment of retrosternal goiter. The Ukrainian Journal of Clinical Surgery. 2021; 88 (1–2): 45–49.

11. Vakkasov M. KH., Khuzhamberdiyev A. U., Islamova Kh. D., Mamadzhanov A. I., Zakhidov R. K. Cervical-substernal goiter: diagnosis and choice of surgical tactics. Re-health journal. 2023; 3 (19): 175–186 (In Russ.).

12. Karpatskiy I. V., Matveyeva Z. S., Shudayev I. R., Akinchev A. L. The role of modern diagnostic methods in determining surgical tactics in patients with cervical-substernal goiter. Detskaya meditsina Severo-Zapada = Children's medicine of the North-West. 2023; 11 (2): 103–112 (In Russ.).

13. Ivanov YU. V., Lomakin I. A., Kolbenev E. I., Yepifantsev E. A., Zlobin A. I. Features of planning and performing surgical operations for cervical-substernal localization of nodular goiter. Novosti khirurgii = Surgery news. 2022; 30 (6): 501–509 (In Russ.).