Overview
A substernal goiter (SG) is an enlarged thyroid gland that extends below the thoracic inlet into the mediastinum 1. While often asymptomatic, SGs can cause compressive symptoms due to their location 1.Diagnosis
Preoperative risk factors for sternotomy in SG patients include goiter extension below the aortic arch, posterior mediastinal extension, and extension below the carina 1.
A longer duration of goiter history and symptomatic SGs are also associated with an increased need for sternotomy 1.Management
Surgical intervention is the primary management for substernal goiters, particularly those causing compressive symptoms or with identified risk factors for sternotomy 1.
Predictors of sternotomy can be identified preoperatively, allowing for enhanced surgical planning and informed consent 1.Key Recommendations
Preoperative identification of risk factors such as goiter extension below the aortic arch, posterior mediastinal extension, and extension below the carina can anticipate the need for sternotomy 1. (Evidence: Moderate)
A longer history of goiter and symptomatic substernal goiters are associated with an increased likelihood of requiring sternotomy 1. (Evidence: Moderate)
Preoperative risk factor assessment can enhance surgical planning and patient consent for substernal goiter management 1. (Evidence: Moderate)References
1 Alqutub AT, Alqutub AT, Alqutub AT, Alqutub HT, Alqutub TT, Alqutub ST et al.. Predictors of Sternotomy in Substernal Goiter Patients: A Systematic Review and Meta-Analysis. The Journal of surgical research 2025. link