• A goiter was defined as substernal or mediastinal for the purposes of this study if its lower border was found radiologically to reach the level of the transverse processes of the fourth thoracic vertebra or lower. Thirty-one patients with such goiters were operated on in a 10-year period. Fourteen were asymptomatic, and the diagnosis was made radiologically. The entrapment of the enlarging goiter is usually a gradual process, and there is danger of tracheal obstruction and other symptoms of mediastinal pressure as well as the slight possibility of malignancy. Carcinoma was found only once; in all other cases the mass was benign. The final pathological diagnoses were fetal adenoma, 14; colloid adenomatous goiter, 11; microfollicular adenoma with focal hyperplasia, 6; and carcinoma, one. The initial incision was the standard collar-type in all instances and proved adequate in 28; further incision through the upper part of the sternum was necessary in 2, and supplementary posterolateral thoracotomy on the left was necessary in one. The ages of the patients ranged from 28 to 78 years, and the only postoperative death was that of a woman aged 74.
Lindskog GE, Goldenberg IS. DIFFERENTIAL DIAGNOSIS, PATHOLOGY, AND TREATMENT OF SUBSTERNAL GOITER. JAMA. 1957;163(7):527-529. doi:10.1001/jama.1957.02970420009004