Treatment of obstructive or substernal goiter
- Douglas S Ross, MD
Douglas S Ross, MD
- Section Editor — Thyroid Disease
- Professor of Medicine
- Harvard Medical School
Goiter refers to abnormal growth of the thyroid gland. Patients with long-standing goiters (cervical or substernal) may develop symptoms of obstruction due to progressive compression of the trachea or sudden enlargement (usually accompanied by pain) secondary to hemorrhage into a nodule. The most common obstructive symptom is exertional dyspnea, which is present in 30 to 60 percent of cases, and usually occurs when the tracheal diameter is under 8 mm. Substernal goiter may be detected incidentally on chest radiograph or computed tomography (CT) scan or found because of obstructive symptoms such as dyspnea, wheezing, or cough.
The treatment of obstructive and substernal goiters will be reviewed here. The clinical manifestations and evaluation of goiter and the management of benign nonobstructive goiter are reviewed separately.
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- ANATOMIC RELATIONSHIPS
- GOALS OF THERAPY
- OUR APPROACH
- Obstructive symptoms
- Asymptomatic substernal goiter
- Preoperative assessment
- Surgical approach
- - Recurrent laryngeal nerve injury
- - Hypocalcemia
- - Tracheomalacia
- Levothyroxine after surgery
- POOR OPERATIVE CANDIDATES
- Radioiodine therapy
- - Recombinant human TSH
- SUMMARY AND RECOMMENDATIONS