Mediastinal goiters. The need for an aggressive approach
L. E. Sanders, R. L. Rossi, D. M. Shahian and W. A. Williamson
Department of General Surgery, Lahey Clinic Medical Center, Burlington, Mass. 01805.
We reviewed the cases of 52 patients with substernal goiters to examine
clinical presentation, workup, technique of removal, malignancy, and
outcome. Half of the patients were asymptomatic; half had at least one
compressive symptom. Chest film was the most used; computed tomography or
magnetic resonance imaging was by far the most useful study. Thyroid scans
often failed to show the intrathoracic goiter. Fine-needle aspiration was
not helpful because of the gland's inaccessibility. Seventeen percent
(nine) of the thyroids showed malignancy, 21% (11) including incidental
papillary carcinomas. These were not identified by duration of goiter,
symptoms, or fine-needle aspiration. Except for lymphomas, prognosis was
good after resection. Removal was almost always accomplished via cervical
incision, with low morbidity and no deaths. The threat of compression, the
substantial chance of malignancy, and the safety of resection mean that the
presence of substernal goiter is an indication for surgery.
