Abstract

This article aims at reviewing the challenges in the diagnosis and management of the secondary retrosternal goiter (SRG). We have searched relative current literature and discussed principle issues of debate and controversy. The definition of SRG meaning a goiter descending to the thoracic inlet is not universally accepted, and this leads not only to variability in given incidence rates, but also to difficulty in recommendation of surgical indication, as well as to comparison of results. SRGs are initially asymptomatic, occasionally impalpable, and may incidentally be diagnosed. When symptoms occur, they are severe and related to the progressive compression and dislocation of the aerodigestive tract (most commonly) and of the adjacent vascular or nervous structures. The diagnosis should be clinically oriented, but imagistic studies are necessary, as is a various laboratory work-up, for definitive confirmation. Computed tomography scan is very useful for evaluating the tracheal intubation and planning surgery. Another issue of concern is the potential malignant risk of a long-standing SRG, ranging variably. Issue of debate is the use of medical treatments. Surgical removal of the SRG represents a challenge to the skilled surgeon in high-volume centers, and is widely considered as the gold standard management in all symptomatic and most of the asymptomatic cases, even if it involves a higher risk of complications compared to cervical goiters. Several studies have indicated improved breathing and swallowing outcomes after thyroidectomy. Debate exists with the use of novel surgeries.

Keywords: retrosternal goiter, substernal goiter, mediastinal goiter, intrathoracic goiter, diagnosis, thyroidectomy.