IJCEM Copyright © 2008-All rights reserved. Published by e-Century Publishing Corporation, Madison, WI 53711
Int J Clin Exp Med 2013;6(7):488-496

Original Article
Surgical treatment of large substernal thyroid goiter: analysis of 12 patients

Bo Gao, Yan Jiang, Xiaohua Zhang, Jianjie Zhao, Yujun He, Yayuan Wen, Shu Zhang, Donglin Luo

Department of Surgery for Breast and Thyroid, Institute of Surgery Research, Daping Hospital, Third Military Medical University,
Chongqing 400042, China. Equal contributors.

Received June 20, 2013; Accepted July 5, 2013; Epub August 1, 2013; Published August 15, 2013

Abstract: This study was carried out to evaluate the clinical presentation, surgical treatment, complications, and risk of malignancy for
large substernal goiter. From March 2010 to December 2012, 12 patients with large substernal thyroid goiter who underwent surgery in
our Department were enrolled in the study. Their medical records were retrospectively analyzed. Collar-shaped incision was adequate
for resection of the lesions in 10 (83%) patients, while two (17%) patients required combined cervical-thoracic incision. In addition, one
case was subjected to postoperative tracheotomy. Transient hypocalcaemia occurred in one case. The incidence of transient
hoarseness, tracheomalacia and hypothyroidism was 8.3%. There was no perioperative bleeding, thyroid storm as well as other
serious complications. All patients were clinically cured. Therefore, cervical collar incision is nearly always adequate for most cases of
larger substernal goiter, and sternotomy can be avoided. Furthermore, the application of intraoperative ultrasonic knife can effectively
reduce intraoperative and postoperative complications. Aggressive perioperative management is crucial for the successful removal of
large substernal goiter. (IJCEM1306019).

Keywords: Substernal goiter, operative approach, ultrasonic knife, complications

Address correspondence to: Dr. Donglin Luo, Department of Surgery for Breast and Thyroid, Institute of Surgery Research, Daping
Hospital, Third Military Medical University, Chongqing 400042, China. E-mail: luodonglin@dphospital.tmmu.edu.cn;
luo32432@sina.com