Journal List > Int J Thyroidol > v.8(2) > 1082727

Int J Thyroidol. 2015 Nov;8(2):211-215. Korean.
Published online November 30, 2015.
Copyright © 2015. the Korean Thyroid Association. All rights reserved.
Combined Cervical and Video-Assisted Thoracoscopic Approch for Huge Substernal Goiter
Wan Seok Cho,1 Sang Yun Song,2 Ho-Cheol Kang,3 and Tae Mi Yoon1
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.

Correspondence: Tae Mi Yoon, MD, PhD, Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun 519-763, Korea. Tel: 82-61-379-8190, Fax: 82-61-379-8199, Email:
Received March 18, 2015; Revised May 07, 2015; Accepted May 30, 2015.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.

Keywords: Substernal goiter; Video-assisted thoracic surgery; Chylothorax


Fig. 1
CT scans with contrast enhancement shows heterogeneous enhanced substernal goiter extending into anterior mediastinum. This substernal mass (black arrow) is located under the tracheal carina (white arrow) and aortic arch (black arrow head) (A. coronal view, B. axial view).
Click for larger image

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).
Click for larger image

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

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