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Retrosternal thyroid surgery

Substernalthyroid - surgery; Mediastinal goiter - surgery

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 behind the breastbone (sternum).

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Description

A retrosternal goiter is always a consideration in people who have a mass in their neck. A retrosternal goiter often causes no symptoms for years. It is often detected when a chest x-ray or CT scan is done for another reason. Any symptoms are usually due to pressure on nearby structures, such as the windpipe (trachea) and swallowing tube (esophagus).

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

During the surgery:

• You receive general anesthesia. This makes you asleep and unable to feel pain.
• You lie on your back with your neck slightly extended.
• Your surgeon makes a cut (incision) in the front of your lower neck just above the collar bones 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 goiter is deep inside the chest, your 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.
• The incisions are closed with stitches (sutures).

Why the Procedure is Performed

This surgery is done to completely remove the goiter. If it is not removed, it can put pressure on your trachea and esophagus.

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

Risks

Risks of anesthesia and surgery in general are:

• Reactions to medicines
• Breathing problems
• Bleeding, blood clots, infection

Risks of retrosternal thyroid surgery are:

• Damage to parathyroid glands (small glands near the thyroid) or to their blood supply, resulting in low calcium
• Damage to the trachea
• Perforation of the esophagus
• Vocal cord injury

Before the Procedure

Tell your surgeon or nurse if:

• You are or could be pregnant
• You are taking any medicines, including drugs, supplements or herbs you bought without a prescription

During the weeks before your surgery:

• You may need to have tests that show exactly where your thyroid gland is located. This will help your surgeon find the thyroid 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. 

During the week before your surgery:

• You may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Many prescription medicines are also blood thinners.
• Fill any prescriptions for pain medicine and calcium you will need after surgery.
• If you smoke, try to stop. Ask your provider for help.
• Ask your surgeon which medicines you should still take on the day of surgery.

On the day of surgery:

• Follow instructions about when to stop eating and drinking.
• Take the medicines your surgeon told you to take with a small sip of water.
• Arrive at the hospital on time.

After the Procedure

You may need to stay in the hospital overnight after surgery so you can be watched 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.

You will likely be able to get up and walk on the day of or day after surgery. It should take about 4 to 6 weeks for you to fully recover.

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

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

Outlook (Prognosis)

Outcome of this surgery is usually excellent. Most people need to take thyroid hormone pills (thyroid hormone replacement) for the rest of their lives when the whole gland is removed.

References

Pace-Asciak P, Russell JO, Razavi CR, et al. Surgical management of thyroid disease. In: Robertson RP, Giudice LC, Grosman AB, eds. DeGroot's Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 82.

Patel KN, Yip L, Lubitz CC, et al. Executive summary of the American Association of Endocrine Surgeons guidelines for the definitive surgical management of thyroid disease in adults. Ann Surg. 2020;271(3):399-410. PMID: 32079828 pubmed.ncbi.nlm.nih.gov/32079828/.

Suh I, Sosa JA. Thyroid. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 37.

Review Date: 3/31/2024  

Reviewed By: Debra G. Wechter, MD, FACS, General Surgery Practice Specializing in Breast Cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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