Recurrent substernal nodular goiter: Incidence and management - Discussion

Background. Surgery for recurrent multinodular goiter is associated with an increased risk of complications. When recurrence occurs in a substernal location, difficulties associated with surgical removal may be even more significant. Methods. Information relating to indications for surgery, procedure performed, pathologic findings, and surgical complications was obtained from a prospective thyroid surgery database maintained in our unit for the past 39 years. Results. During the study period 234 patients underwent operation for retrosternal recurrence of a nodular goiter. In the majority of cases (51%) the indication for surgery was the presence of compressive symptoms. In only four cases was a sternal split required to remove substernal recurrence. Complications occurred in 35 patients, including four permanent recurrent laryngeal nerve palsies. No patient had permanent hypoparathyroidism. Conclusions. Surgery for recurrent substernal goiter, although technically demanding, can be performed with a minimum of morbidity if appropriate attention is paid to anatomy and embryology. A sternal split is only rarely required.