Int J Thyroidol.  2015 Nov;8(2):211-215. 10.11106/ijt.2015.8.2.211.

Combined Cervical and Video-Assisted Thoracoscopic Approch for Huge Substernal Goiter

  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.
  • 2Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.
  • 3Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.


Substernal goiter is defined as a thyroid mass of which more than half is located below the thoratic inlet. Substernal goiters must be removed surgically due to relation to compressive symptoms, potential airway compromise, and the possibility of an association with malignancy. Thyroidectomy for substernal goiter is usually carried out through a standard cervical approach. However, a few patients with various factors require an extracervical approach, usually by sternotomy. Recently, we successfully removed a substernal goiter that extended to the lower level of the aorta and tracheal carina though the combined cervical and video-assisted thoracoscopic approach. We present this case with a review of the literature.


Substernal goiter; Video-assisted thoracic surgery; Chylothorax

MeSH Terms

Goiter, Substernal*
Thoracic Surgery, Video-Assisted
Thyroid Gland


  • Fig. 1. CT scans with contrast enhancement shows heterogeneous enhanced su-bsternal goiter extending into anterior mediastinum. This substernal mass (black ar-row) is located under the tr-acheal carina (white arrow) and aortic arch (black arrow head) (A. coronal view, B. axial view).

  • Fig. 2. Chest X-ray shows left costophrenic angle blunting which is indicated with left pleural effusion (A) and it is improved with conservative treatment (B).

  • Fig. 3. Photograph of the surgical specimen shows about longitudinal 9-cm-sized mass originated in inferior portion of left thyroid lobe.



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