Surgical management of intrathoracic goiters: 20 years experience

Zribi Hazem, Abdelkabir Amina, Bouassida Imen, Abdennadher Mahdi, Maazaoui Sarra, Neji Henda, Marghli Abdel


Background: Surgery is necessary for intrathoracic goiters (ITG) even in asymptomatic forms considering the risks of compression and malignancy. The major problem is the adequate approach.  Intrathoracic goiter’s removal can be performed via a cervical approach, whereas sternotomy might be required intraoperatively in some cases.

Methods: A retrospective analysis of twenty years on 122 cases of intrathoracic goiters in a referral centre for thoracic surgery was carried out.  We included secondary substernal goiters and ectopic thoracic goiters.

Our aim was to define the specifities of this surgery and its outcomes. Postoperative data were examined as well as morbidity and mortality factors.

Results: The most common symptoms included dyspnea, cough and dysphagia. Whereas Twenty-two patients were asymptomatic. One hundred sixteen patients underwent a successful transcervical incision without thoracic approach. Six cases of primary goiters were noted, of whom 3 were extracted via a cervical approach. Two cases showed unilateral recurrent nerve paralysis and two cases a hypoparathyroidism.

Conclusions: Surgical management of intrathoracic goiter was correlated with low morbidity and mortality The cervical approach was performed in the vast majority of cases without an extra cervical procedure.  Intrathoracic approaches were restricted to some selected indications.


Goiter, Substernal, Thoracotomy, Sternotomy, Morbidity

Full Text:



Vaiman M, Bekerman I, Basel J, Peer M. Surgical approach to the intrathoracic goiter. Laryngoscope Investig Otolaryngol. 2018;3(2):127‐32.

Polistena A, Sanguinetti A, Lucchini R, Galasse S, Monacelli M, Avenia S, et al. Surgical approach to mediastinal goiter: An update based on a retrospective cohort study. Int J surg. 2016;28(1):S42-6.

Can AS, Nagalli S. Substernal Goiter. [Updated 2020 Apr 24]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.

Wong WK, Shetty S, Morton RP, McIvor NP, Zheng T. Management of retrosternal goiter: Retrospective study of 72 patients at two secondary care centers. Auris Nasus Larynx. 2019;46(1):129-134.

Polistena A, Monacelli M, Lucchini R, Triola R, Conti C, Avenia S, et al. Surgical management of mediastinal goiter in the elderly. International journal of surgery. 2014;12(2):S148-52.

Sorensen JR, Hegedus L, Kruse-Andersen S, Godballe C, Bonnema SJ. The impact of goitre and its treatment on the trachea, airflow, oesophagus and swallowing function. A systematic review. Best practice and res Clin endocrinol metabolism. 2014;28(4):481-94.

Khan MN, Goljo E, Owen R, Park RC, Yao M, Miles BA. Retrosternal Goiter: 30-Day Morbidity and Mortality in the Transcervical and Transthoracic Approaches. Otolaryngology--head and neck surgery: official J Am Aca Otolaryngol-Head and Neck Surg. 2016;155(4):568-74.

Crile G. Intrathoracic goiter. Cleve Clin Quarterly. 1939;6:313-22.

Wang X, Zhou Y, Li C, Cai Y, He T, Sun R ,et al. Surgery for retrosternal goiter: cervical approach. Gland Surg. 2020;9(2):392‐400.

Lin YS, Wu HY, Lee CW, Hsu CC, Chao TC, Yu MC. Surgical management of substernal goitres at a tertiary referral centre: A retrospective cohort study of 2,104 patients. Int Jsurg. 2016;27:46-52.

Cougard P, Peix JL, Kraimps JL. Low-risk papillary thyroid cancer. What is the procedure of choice for thyroidectomy and lymph node resection? Annde c hirurgie. 2005;130(6-7):411-3.

Bodner J, Lottersberger CA, Kirchmayr W, Schmid T. Ectopic mediastinal thyroid adenoma. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery. 2004;26(1):211-2.

Rodrigues J, Furtado R, Ramani A, Mitta N, Kudchadkar S, Falari S. A rare instance of retrosternal goitre presenting with obstructive sleep apnoea in a middle-aged person. International journal of surgery case reports. 2013;4(12):1064-6.

Cohen JP. Substernal goiters and sternotomy. The Laryngoscope. 2009;119(4):683-8.

de Perrot M, Fadel E, Mercier O, Farhamand P, Fabre D, Mussot S, et al. Surgical management of mediastinal goiters: when is a sternotomy required? The Thoracic and cardiovascular surgeon. 2007;55(1):39-43.

Rolighed L, Ronning H, Christiansen P. Sternotomy for substernal goiter: retrospective study of 52 operations. Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie. 2015;400(3):301-6.

Friedman M, Ibrahim H, Ramakrishnan V. Cervical approach for large thyroid mass with substernal extension. Oper Tech Otolaryngol-Head and Neck Surgery. 2003;14(2):90-3.

Flati G, De Giacomo T, Porowska B, Flati D, Gaj F, Talarico C, et al. Surgical management of substernal goitres. When is sternotomy inevitable? La Clinica terapeutica. 2005;156(5):191-5.

Hajhosseini B, Montazeri V, Hajhosseini L, Nezami N, Beygui RE. Mediastinal goiter: a comprehensive study of 60 consecutive cases with special emphasis on identifying predictors of malignancy and sternotomy. Am J surg. 2012;203(4):442-7.

Sancho JJ, Kraimps JL, Sanchez-Blanco JM, Larrad A, Rodriguez JM, Gil P, et al. Increased mortality and morbidity associated with thyroidectomy for intrathoracic goiters reaching the carina tracheae. Arch surg (Chicago, Ill : 1960). 2006;141(1):82-5.

Christou N, Mathonnet M. Complications after total thyroidectomy. J visceral surg. 2013;150(4):249-56.

Hashmi SM, Premachandra DJ, Bennett AM, Parry W. Management of retrosternal goitres: results of early surgical intervention to prevent airway morbidity, and a review of the English literature. The J laryngol and otol. 2006;120(8):644-9.

Pieracci FM, Fahey TJ. Substernal thyroidectomy is associated with increased morbidity and mortality as compared with conventional cervical thyroidectomy. J Am Coll Surg. 2007;205(1):1-7.

Hedayati N, McHenry CR. The clinical presentation and operative management of nodular and diffuse substernal thyroid disease. Am surg. 2002;68(3):245-51.

Goudet P, Ragois P, Guergah M, Cougard P. Specific morbidity of substernal goiters. A comparative study with a matched series of cervical goiters. Ann de chirurgie. 1996;50(10):913-7.

Erbil Y, Bozbora A, Barbaros U, Ozarmagan S, Azezli A, Molvalilar S. Surgical management of substernal goiters: clinical experience of 170 cases. Surg Today. 2004;34(9):732-6.