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Retrosternal thyroid surgery

The thyroid gland is normally located at the front of the neck. A retrosternal thyroid refers to the abnormal placement of all or part of the thyroid gland below the breastbone (sternum).

This article discusses surgery for a retrosternal thyroid.

A retrosternal goiter is always a consideration in patients who have a mass sticking out of the neck. Most retrosternal goiters cause no symptoms for years. Most are detected when a chest x-ray is done for another reason. Any symptoms are usually due to pressure on nearby structures such as the trachea and esophagus.

Surgery to completely remove the goiter is recommended, even if you do not have symptoms.

You will receive general anesthesia. This will make you unconscious and unable to feel pain.

You will remain flat on your back with your neck slightly extended. The surgeon will make a 3-4 inch cut in the neck to determine if the mass can be removed without opening the chest. Most of the time, the surgery can be done this way.

If the mass is deep inside the chest, the surgeon will make a surgical cut along the middle of your chest bone. The entire goiter will be removed. A tube may be left in place for a while to drain fluid and blood. It is usually removed in 1-2 days.

Alternative Names

Substernalthyroid - surgery; Mediastinal goiter - surgery

Indications

There is no way to tell if a retrosternal thyroid is cancer or not. This test is done to completely remove the mass. If it is not removed, it can put pressure on your airways and food tube (esophagus).  

If the retrosternal goiter has been there for a long time, you may have difficulty swallowing food, mild pain in the neck area, and shortness of breath. 

If your doctor thinks you may have a retrosternal thyroid, you will have the following tests done before any surgery:

  • Blood calcium test
  • CT or MRI scan of the neck and chest
  • Thyroid function tests
  • Barium swallow test to check your esophagus
  • Lung function tests to check for airway blockage

Risks

The risks for any anesthesia are:

  • Allergic reactions to medicines
  • Breathing problems

The risks for any surgery are:

  • Bleeding
  • Infection

Risks of retrosternal thyroid surgery are:

  • Bleeding
  • Vocal cord paralysis
  • Damage to parathyroid glands resulting in low calcium
  • Wound infection
  • Damage to the trachea
  • Perforation of esophagus

Expectations after surgery

A patient usually does well after the retrosternal thyroid is removed. It doesn't usually return. Adding iodized salt to your meals can help prevent a recurrence.

Symptoms often go away immediately, if there are no surgery complications.

Before You Have the Procedure

Before deciding on surgery, your doctor or nurse will examine you carefully. Blood work and imaging tests will be done.

What you need to do:

  • Tell your doctor or nurse about all the medicines you take, even those bought without a prescription. This includes herbs and supplements.
  • Ask your doctor or nurse which medicines you can or should still take on the day of your surgery.

Two weeks before surgery:

  • You may need to stop taking any drugs that make it harder for your blood to clot. This includes aspirin,ibuprofen (Advil, Motrin), clopidogrel (Plavix), and naprosyn (Aleve, Naproxen).
  • If you smoke, you need to stop. Ask your doctor or nurse for help.
  • Tell your doctor or nurse if you get a cold, flu, fever, herpes or cold sore breakout, or any other sickness before your surgery.

On the day of your surgery:

  • Do not drink anything after midnight the day of your surgery. This includes water.
  • Take any drugs your doctor prescribed with a small sip of water.

Convalescence

You may have a drain in your neck after surgery. It will drain fluid that builds up in the area. It will be removed within a day.

You may need to stay in the hospital overnight after surgery so a nurse can watch for any bleeding, change in calcium level, or breathing problems.

You may need to go home the next day if the surgery was done through the neck. If the chest was opened up, you may stay in hospital for several days.

References

Randolph GW, Shin JJ, Grillo HC, et al. The surgical management of goiter: Part II. Surgical treatment and results. Laryngoscope. 2011;121(1):68-76.

Shin JJ, Grillo HC, Mathisen D, et al. The surgical management of goiter: Part I. Preoperative evaluation. Laryngoscope. 2011;121(1):60-67.

Smith PW, Salomone LJ, Hanks JB. Thyroid. In: Townsend CMJr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 38.

Updated: 7/15/2012

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.


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