Morbidity and mortality of thyroidectomy for substernal goiter.

BACKGROUND: Our objective was to evaluate morbidity and mortality of thyroidectomy in substernal goiters and identify patients at risk for these events.

METHODS: The medical records of 127 patients with substernal goiters were retrospectively reviewed.

RESULTS: The most common preoperative symptom was shortness of breath (48%). 13% of the 127 patients were asymptomatic. Preoperative imaging identified tracheal deviation in 69% and tracheal compression in 41% of the cases. Substernal goiters were resected via a cervical approach in 100% of the cases. Six patients (5%) had postoperative hoarseness, 1 had permanent vocal cord paralysis, and 19 (15%) had transient postoperative hypocalcemia. The mortality and permanent hypoparathyroidism were null. Patients with postoperative complications had larger goiters and were more likely to have tracheal compression.

CONCLUSIONS: Thyroid resection via a cervical approach for substernal goiters is associated with low rate of morbidity and no mortality. Patients with large tumors and tracheal compression are more likely to develop postoperative complications.