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(Retrosternal Goiter)

Definition

A goiter is a thyroid gland that has grown larger than it should. This type of goiter grows downward into the chest. It can press on pathways to your lungs or stomach and cause problems.

Causes

The thyroid makes important chemicals called hormones. They are needed to help the body work well. The thyroid may grow too large if it cannot not make enough hormones. This may happen because:

  • The thyroid is damaged and does not work well.
  • Signals from the brain are not working as they should. They tell the thyroid to work harder than it needs to.
  • Iodine levels are too low. It is needed to make thyroid hormones.

Some goiters can also be caused by a problem with genes or growths like tumors.

Risk Factors

The risk of a substernal goiter is higher in people who:

  • Smoke
  • Have certain genes or a family members with goiters
  • Have thyroid problems such as hypothyroidism or hyperthyroidism
  • Have diet low in iodine

Symptoms

Goiters tend to grow slowly. It may be many years before it is large enough to cause symptoms. Substernal goiters can cause:

  • Breathing problems—especially when lying down
  • Cough
  • High-pitched sound while breathing
  • Swallowing problems—food may feel like it is moving slowly from the throat to the stomach
  • Choking
  • Hoarse voice

Diagnosis

You will be asked about your symptoms and past health. A goiter can be found during a physical exam. Blood tests will help to show changes in hormone levels. Image tests will show where the thyroid has grown. Test may include:

Treatment

Surgery can be used to remove extra tissue. This will often ease symptoms. Surgery may be delayed until symptoms appear. Some goiters will continue to grow. Other treatment may be needed to balance problems caused by the goiter.

After surgery, medicine will then be needed to replace thyroid hormones.

Prevention

Some goiters can be prevented by getting enough iodine in the diet.

RESOURCES

American Thyroid Association  https://www.thyroid.org 

Hormone Health Network—Endocrine Society  https://www.hormone.org 

CANADIAN RESOURCES

Health Canada  https://www.canada.ca 

Thyroid Foundation of Canada  https://thyroid.ca 

References

Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules—2016 update. Endocr Pract. 2015;22(5):622-639.

Goiter. American Thyroid Association website. Available at: https://www.thyroid.org/goiter. Accessed April 5, 2019.

Goiter. Baylor College of Medicine website. Available at: https://www.bcm.edu/healthcare/care-centers/endocrine-surgery-clinic/procedures/goiter. Accessed April 5, 2019.

Hardy RG, Bliss RD, Lennard TW, Balasubramanian SP, Harrison BJ. Management of retrosternal goitres. Ann R Coll Surg Engl. 2009;91(9):8-11.

Multinodal goiter. EBSCO DynaMed Plus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T115919/Multinodular-goiter . Updated October 4, 2015. Accessed April 5, 2019.

Multinodal goiter. Saint John’s Health Center website. Available at: https://california.providence.org/saint-johns/services/surgery/thyroid-surgery/multinodular-goiter. Accessed April 5, 2019.

What is a retrosternal (sub-sternal) goitre? Endocrine Surgeon UK website. Available at: http://www.endocrinesurgeon.co.uk/index.php/what-is-a-retrosternal-sub-sternal-goitre. Accessed April 5, 2019.

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