The thyroid gland is normally located at the front of the neck. A retrosternal thyroid is when all or part of the thyroid gland is abnormally located below the breastbone (sternum).
Substernal thyroid; Mediastinal goiter
Goiters have become less common in the U.S. over the past three decades. This decrease is mostly due to more iodide in the diet. However, although there are fewer goiters, retrosternal goiters are still a possibility in patients who have a growth in their neck.
Most retrosternal goiters have no symptoms for many years. Most are found on routine chest x-rays. When symptoms do occur, they are usually due to pressure on nearby structures, such as the trachea and esophagus.
Cancer is always a concern when a patient has a large growth in the neck. However, unlike with other growths, fine needle aspiration is not recommended to diagnose retrosternal goiters.
Surgery to remove the growth is recommended, even if the patient has no symptoms.
During this surgery, you will receive general anesthesia. This means you will be asleep and pain-free.
You will lie flat on your back with your neck slightly extended.
The surgeon will make a 3 - 4 inch surgical cut in the neck to determine whether the growth can be removed without opening the chest. Most of the time, retrosternal goiters can be removed without a neck cut.
If the growth is deep inside the chest, the surgeon may need to open the chest. This involves making a surgical cut along the middle of your chest bone. In many cases, a small cut in the breastbone is enough.
The entire goiter will then be removed.
The surgeon may leave in a drainage tube to drain fluid and blood. This drain is usually removed in 2 - 3 days.
All of the wounds will be closed with sutures and dressings will be applied.
Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.