Endocrine Abstracts

Introduction: The definition of a substernal goiter is not univocal, several definitions have been advanced. It poses difficulties by its therapeutic features and management. The aim of this presentation was to detail the particularities of the management of substernal goiters and their therapeutic difficulties.

Methods: This is a retrospective study carried out on 40 patients with substernal goiter admitted to our department and treated during a period of 5 years (from 2012 to 2017).

Results: They were 13 men and 27 women. The average age was 52 years. The main complaint was a cervical mass found in all cases, associated with signs of compression in 15 cases. The size of the mass ranged from 3 to10 cm with an average of 7 cm. The patients were in clinical euthyroidism in 33 cases. The radiological assessment included cervical examination ultrasound and cervico-mediastinal CTscan in all cases. A total thyroidectomy was performed in 26 cases and a loboisthmectomy in 14 cases. The cervical approach was sufficient in the majority of cases. We used sternotomy in two cases. The malignancy rate was 12%. It was a papillary carcinoma in four cases and medullary in one case. A central compartment dissection was practiced in five cases and lateral in 1 case. I¹³¹ remnant ablation was performed for papillary carcinomas with a dose of 50 to 300 mci. External radiotherapy was performed for the case of medullary carcinoma for curative purposes. All patients with benign goiters had a good outcome over the course of follow-up time.

Conclusion: Generally benign, the surgery of substernal goiter is more difficult than that of cervical goiter. The cervical approach is often sufficient; however, a sternotomy is sometimes needed. The prognosis depends on a good preoperative preparation and rigorous postoperative follow-up.