ABSTRACT

Retrosternal goiter (RSG) is not very common, but it has special merit in diagnosis and management.

RSG is defined in various ways in literature; all of them have limitations. Classification of RSG depending on pre-operative and per-operative findings has enormous surgical merit.

Category 1:The RSG with a portion in the neck and a portion behind the sternum usually derives its blood supply from the neck vessels and can be removed by cervical incision without significant bleeding or complications.

Category2:Agoiter that sinks entirely into the mediastinum; if the lower limit is not approachable digitally via cervical incision or a primary mediastinal thyroid which is likely to derive blood supply from mediastinal vessels, it should be removed via sternotomy.

Category 3: The RSG with high clinical and radiological suspicion of malignancy may require sternotomy.

A study in Bangladesh shows, out of 1,091 thyroids operated, 26 cases (2.38%) presented as RSG.

Sex ratios among cervical goiter (2.75:1) and RSG (2.25:1) are similar. Age span:cervical goiter 9–78 years, RSG 27–70 years. Mean age at presentation: cervical goiter 40 years (SD 14.33), RSG 53 years (SD: 12.29).

Among these 26 RSG patients, three required thoracic approaches (3 Sternotomy),11.54%.

Complications of surgery like RLN palsy, parathyroid insufficiency and post-operative bleeding are higher in RSG.

Despite these facts, RSG should be treated surgically even if it is asymptomatic because the cytopathological nature is sometimes difficult to obtain and to avoid unwanted complications as the goiter may continue to grow bigger.