A surgical algorithm for the management of retrosternal goiters

Key points

Introduction

Retrosternal goiter refers to those which partially or completely extend posterior to the sternum. They may be classified either as primary, due to ectopic thyroid tissue, or secondary, due to the direct downwards migration of thyroid tissue.1The primary goal in the treatment of retrosternal goiters is often to relieve obstructive symptoms using surgical resection, with numerous grading systems being developed to help clinicians guide operative choices. Delbridge 2 based his classification on the relationship between the cervical and thoracic components of the thyroid tissue; Page, Strunski 3 and Huins, Georgalas, Mehrzad, Tolley4 based their classification on the extent of inferior extension of the goiter; and Randolph, Shin, Grillo, Mathisen, Katlic, Kamani, Zurakowski 5 based their classification on the direction of extension, either into the anterior or posterior mediastinum. Still, the heterogeneity of goiter size and location, nearby anatomical structures, and evolving surgical techniques means selecting the most appropriate individualised surgical approach remains challenging.