Background: Retrosternal goiter is an enlarged thyroid extending into the mediastinum, causing diagnostic and surgical challenges due to potential airway and oesophageal compression. Methodology: This retrospective study examined patients undergoing thyroidectomy for retrosternal goiter over 10 years at a South Indian tertiary center. Data included demographics, clinical presentation, anatomy, surgical details, complications, and histopathology, analyzed with SPSS27. Results: Of 2110 thyroidectomies performed, 90 (4.26%) involved retrosternal goiters. The cohort showed female predominance (male:female ratio 1:3.7) and a mean age of 47.2 ± 12.0 years. Most patients (80%) presented with neck swelling; 10% had respiratory symptoms, while 10% were diagnosed incidentally. A cervical approach sufficed in 93% of cases, including those with retrosternal extension up to 9 cm. Thyrothymic rests (TTR) contributed to the retrosternal component in 54% of cases. Only six patients required sternotomy or thoracotomy. Temporary hypocalcaemia occurred in 20%, nerve injury in three patients (all recovered), and there were no perioperative mortalities. Malignancy was identified in 16.7% of cases. All patients were discharged following uneventful recovery. Conclusions: Retrosternal goiter represents a minority of thyroidectomies but can be managed safely and effectively in a high-volume center, with complication rates lower than commonly cited in the literature. The cervical approach is feasible for most cases, including those with significant mediastinal extension. Thorough assessment for TTR is essential to achieve complete excision and optimize the outcomes.
Sadacharan et al. (Thu,) studied this question.