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Retrosternal thyroid surgery

Definition

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

This article discusses surgery for a retrosternal thyroid.

Alternative Names

Substernalthyroid - surgery; Mediastinal goiter - surgery

Description

A retrosternal goiter is always a consideration in patients who have a mass sticking out of the neck. A retrosternal goiter usually causes no symptoms for years. It is often 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.

During the surgery: 

  • You receive general anesthesia. This makes you unconscious and unable to feel pain.
  • You lie on your back with your neck slightly extended.
  • The surgeon makes a 3 to 4 inch surgical cut (incision) in your 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 makes an incision along the middle of your chest bone. The entire goiter is then removed. A tube may be left in place to drain fluid and blood. It is usually removed in 1 to 2 days.

Why the Procedure is Performed

This surgery 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 can have difficulty swallowing food, mild pain in the neck area, and shortness of breath. 

If your doctor thinks you 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

Risks of anesthesia are:

  • Allergic reactions to medicines
  • Breathing problems

Risks of retrosternal thyroid surgery are:

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

Before the Procedure

You may need to have tests that show exactly where your thyroid gland is located. This will help the surgeon find the growth during surgery. You may have a CT scan, ultrasound, or other imaging tests.

You may also need thyroid medicine or iodine treatments 1 to 2 weeks before surgery.

Tell your doctor or nurse about all the medicines you take, even those bought without a prescription. This includes herbs and supplements.

Several days to a week before surgery, you may be asked to stop taking medicines that make it harder for your blood to clot. These include:

  • Aspirin
  • Clopidogrel (Plavix)
  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve, Naprosyn)
  • Warfarin (Coumadin)

You will probably be asked to stop eating or drinking at some point the night before or day of surgery. Your doctor or nurse will give you specific instructions.

Ask your doctor which medicines you should still take the day of surgery.

If you smoke, try to stop. Your recovery time will be shorter if you do not smoke. Ask your doctor or nurse for help.

Your doctor or nurse will tell you when to arrive at the hospital. Be sure to arrive on time.

After the Procedure

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 or so.

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 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.

Most patients are able to get up and walk on the day after surgery. It should take about 3 to 4 weeks for you to fully recover.

You may have pain after surgery. Ask your doctor or nurse for instructions on how to take medicines after you go home.

Follow any instructions for taking care of yourself after you go home.

Outlook (Prognosis)

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

Symptoms often go away quickly if there are no surgery complications.

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 CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 38.


Review Date: 4/9/2014
Reviewed By: Debra G. Wechter, MD, FACS, General Surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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