RESUMEN
Intrathoracic goiter [ITG] or substernal goiter [SSG] includes any thyroid enlargement in which over 50% portion of the thyroid permanently located under the thoracic inlet and lower pole of thyroid is not palpable with the neck in hyperextended position. Between Jan 1993 and July 2002, 334 patients underwent thyroidectomy for goiters in Rasht [North of Iran]. In this investiagation, initial presentations, surgical managements and complications of 32 patients with substernal goiter have been evaluated retrospectively. Results: There were 20 women and 12 men, with a mean age of 40 years [range 45-67 yrs]. Twenty-two patients presented with respiratory symptoms, two had dysphagia, four complained of hoarseness, and five patients were detected incidentally by CXR. Chest X-ray was the first step in diagnosis, and C. T Scan was the best imaging examination for diagnosis. Isotope scanning was helpful only in five patients. Twenty-one patients were operated with the collar incision, seven with collar incision, and in some along with partially sternotomyfour and four patients were operated by median sternotomy. In 17 patients the goiters were in the right anterior mediastinum and in 14, in the left anterior mediastinum, in one patient goiter was seen in the hilum of the right lung. Pathologic reports were as follows: multinodular goiter in 22 patients papillary cell carcinoma in seven patients anaplastic carcinoma in one patient and lymphoma in one patient. Medullary cell carcinoma in one patient. There was no hospital mortality. Postoperative complications occured in five patients. This study recommends that intrathoracic goiter should be operated early under suitable conditions because of malignant transformation and other hemorrhagic or serious complications