A 62-year-old woman presents with a large multinodular goitre extending retrosternally. She has progressive dyspnoea on lying supine and CT chest shows the thyroid mass extending below the thoracic inlet with tracheal compression. What is the definitive surgical management?
- A Radioactive iodine ablation as surgery is contraindicated in retrosternal goitre
- B Median sternotomy to access the retrosternal component safely
- C Total thyroidectomy via a standard cervical collar incision in almost all cases ✓
- D Subtotal thyroidectomy to preserve parathyroid function
Correct answer: C. Total thyroidectomy via a standard cervical collar incision in almost all cases
Explanation
The vast majority of retrosternal (substernal) goitres can be removed through a standard cervical collar incision. Sternotomy is rarely required and reserved for select cases with extension into the posterior mediastinum or suspected malignancy with great vessel involvement. The thoracic inlet can be navigated by delivering the gland upwards. RAI is not definitive for large compressive goitres.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.