Objectives

Substernal thyroid goiters (STGs) often result in tracheal deviation or compression. This study aimed to review postoperative functional and anatomical changes in STG and identify the factors associated with these changes.

Methods

We retrospectively reviewed the medical records of 30 patients (eight men and 22 women) with STG who underwent surgical treatment at our institution between 2008 and 2024. Patients’ ages ranged from 39 to 80 years (mean age, 64 years).

Results

 Tumor sizes ranged from 36–89 mm (average size, 58 mm). The distance of tracheal deviation ranged from 2–26 mm (mean distance, 11.4 mm). Tracheal compression was observed in 22 cases. Total thyroidectomy and hemithyroidectomy were performed in seven and 23 patients, respectively. Histopathological analysis identified multinodular goiter in 19 patients, papillary carcinoma in six, follicular adenoma in three, and follicular carcinoma in two.

Three patients required sternotomy. Postoperative recurrent nerve palsy occurred in six cases, two of which were permanent due to nerve invasion by the malignant tumor. Tracheal deviation improved postoperatively in all patients. Contralateral tracheal deviation beyond the midline was confirmed in eight patients. Tracheal compression completely resolved postoperatively, except in three cases with mild stenosis. Among the 23 patients who underwent hemithyroidectomy, nine had elevated TSH levels, and two exhibited decreased fT4 levels.

Univariate analysis indicated a significantly higher sternotomy rate for malignant tumors than benign tumors (p = 0.014). Postoperative recurrent nerve palsy was observed at a significantly higher rate in patients undergoing total thyroidectomy (p = 0.016) and those with malignant tumors (p = 0.002). Multivariate analysis confirmed a significant association between malignant tumors and postoperative recurrent nerve palsy (p = 0.029).

Conclusions

 Surgical treatment can effectively improve tracheal deviation or compression caused by STG. Malignant tumors may necessitate sternotomy and carry a higher risk of postoperative nerve palsy.