Abstract

The secondary substernal goiter (SSG), originating from the cervical thyroid gland, may cause significant compression effects on neighboring vital structures, in particular compromising the safety of airways. The diagnosis should be clinically oriented and helped by imaging studies. There are still controversies and issues of debate, such as the precise definition, diagnosis, recommendation of indication for surgery, management of specific airway problems at intubation / extubation, or the risk of transformation to malignancy, and the comparison of results. Multidisciplinary approach of SSG in a high-volume center is required to achieve the most optimal outcome. The conservative medical management is reported inadequate. Some controversies surround the rationale of surgery in asymptomatic cases, but this view is recently weakened. Surgical mass removal in all symptomatic and most of the asymptomatic cases, performed electively and via a cervicotomy, is considered as the preferred treatment approach for SSG. Specific anaesthesiologic techniques and use of relative adjuncts to secure and maintain the airways, either in elective or emergent surgery, may be needed. Only rarely are an accessory extracervical approach or an emergency tracheostomy required. In most cases, particularly the elective that are managed by a skilled team, postoperative complications are reported essentially similar to those of standard excisional thyroid surgery. In the vast majority of cases, compressive symptoms attributable to the disease disappear soon after surgery. Conclusively, the surgical removal of the SSG is a challenge but is strongly advocated for patients before or at the first signs of tracheal compression, even if it might involve a higher risk of complications compared to cervical goiters. Herein, the relevant basic knowledge and research has been briefly reviewed.

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