A survey of retrosternal thyroidectomies from one surgeon over 20 years

Abstract

Introduction: A retrosternal goitre is typically defined as an enlargement of the thyroid gland with more than 50% of its volume positioned beneath the thoracic inlet. These goitres are often detected either due to symptoms of exertional dyspnoea or incidentally through radiological imaging. Thyroidectomy, typically via a cervical approach, is commonly performed in cases with pronounced symptoms or radiographic evidence of compression, deviation or marked thyroid enlargement. We present a retrospective analysis of the demographics and management strategies for patients with retrosternal goitres. Material(s) and Method(s):s: Over a 20-year period, a single surgeon (LC) performed 865 thyroid and parathyroid procedures, of which 98 (11.3%) involved retrosternal goitres. Clinical details from these patients undergoing thyroidectomy were analysed. Result(s): Approximately half of the patients were of Afro-Caribbean or Asian descent. The predominant clinical presentations included symptoms of compression and concerns related to neck appearance. The majority of cases were managed with total thyroidectomy, while a smaller proportion underwent subtotal thyroidectomy. Postoperative complications were rare, with transient hypocalcemia and temporary vocal cord changes being the most common. Histopathological analysis predominantly revealed multinodular goitre. Only one patient underwent median sternotomy due to over 80% of goitre being mediastinal. Discussion(s): In rare instances, a median sternotomy is necessary to access goitres extending near or below the aorta. A multidisciplinary approach, involving collaboration with the cardiothoracic team, is crucial for a successful outcome. Conclusion(s): The vast majority of retrosternal goitre can be successfully removed via a conventional cervical approach. However, Maxillofacial surgeons should be aware of the small number of cases that necessitate retrosternal thyroidectomy through a sternal approach.Copyright © 2025