Retrosternal thyroid surgery

A retrosternal goiter should be considered in people who have a mass in their neck. A retrosternal goiter often causes no symptoms for years. It is often detected when a chest x-ray or CT scan is done for another reason. Any symptoms are usually due to pressure on nearby structures, such as the windpipe (trachea) or swallowing tube (esophagus).

Surgery to completely remove the goiter may be recommended, even if you do not have symptoms.

During the surgery:

• You receive general anesthesia. This makes you sleep and unable to feel pain.
• You lie on your back with your neck slightly extended.
• Your surgeon makes a cut (incision) in the front of your lower neck just above the collar bones to determine if the mass can be removed without opening the chest. Most of the time, the surgery can be done this way.
• If the goiter is deep inside the chest, your surgeon makes an incision along the middle of your chest bone. The entire goiter is then removed.
• A tube may be left in place to drain fluid and blood. It is usually removed in 1 to 2 days.
• The incisions are closed with stitches (sutures).

This surgery is done to completely remove the goiter. If it is not removed, it can put pressure on your trachea or esophagus.

If the retrosternal goiter has been there for a long time, you can have difficulty swallowing food, mild pain in the neck area, or shortness of breath.

Risks of anesthesia and surgery in general are:

• Reactions to medicines
• Breathing problems
• Bleeding, blood clots, infection

Risks of retrosternal thyroid surgery are:

• A sharp rise in thyroid hormone levels (only around the time of surgery)
• Damage to the parathyroid glands (small glands near the thyroid) or to their blood supply, resulting in low calcium
• Damage to the trachea
• Perforation of the esophagus
• Injury to the nerves to your vocal cords and larynx

Tell your surgeon or nurse if:

• You are or could be pregnant
• You are taking any medicines, including medicines, drugs, supplements or herbs you bought without a prescription
• You have been drinking a lot of alcohol, more than 1 or 2 drinks a day

During the weeks before your surgery:

• You may need to have tests that show exactly where your thyroid gland is located. This will help your surgeon find the thyroid during surgery. You may have a CT scan, ultrasound, or other imaging tests.
• You may also need thyroid medicine or iodine treatments 1 to 2 weeks before surgery.
• If you have diabetes, heart disease, or other medical conditions, your surgeon may ask you to see the provider who treats you for these conditions.
• If you smoke, it's important to cut back or quit. Smoking can slow healing and increase the risk for blood clots. Ask your provider for help quitting smoking.
• If needed, prepare your home to make it easier to recover after surgery.
• Ask your surgeon if you need to arrange to have someone drive you home after your surgery.

During the week before your surgery:

• You may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Many prescription medicines are also blood thinners. Some herbal supplements can also thin the blood.
• Fill any prescriptions for pain medicine and calcium you will need after surgery.
• Ask your surgeon which medicines you should still take on the day of surgery.
• Let your surgeon know about any illness you may have before your surgery. This includes COVID-19, a cold, flu, fever, herpes outbreak, or other illness. If you do get sick, your surgery may need to be postponed.

On the day of surgery:

• Follow instructions about when to stop eating and drinking.
• Take the medicines your surgeon told you to take with a small sip of water.
• Arrive at the hospital on time.

You may need to stay in the hospital overnight after surgery so you can be watched for any bleeding, change in calcium level, or breathing problems.

You may go home the next day if the surgery was done through the neck. If the chest was opened up, you may stay in hospital for several days.

You will likely be able to get up and walk on the day of or day after surgery. It should take about 4 to 6 weeks for you to fully recover.

You may have pain after surgery. Ask your provider for instructions on how to take pain medicines after you go home.

Follow any instructions for taking care of yourself after you go home.

The outcome of this surgery is usually excellent. Most people need to take thyroid hormone pills (thyroid hormone replacement) for the rest of their lives when the whole gland is removed.

Substernalthyroid - surgery; Mediastinal goiter - surgery

Pace-Asciak P, Russell JO, Razavi CR, et al. Surgical management of thyroid disease. In: Robertson RP, Giudice LC, Grosman AB, et al, eds. DeGroot's Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 82.

Patel KN, Yip L, Lubitz CC, et al. Executive summary of the American Association of Endocrine Surgeons guidelines for the definitive surgical management of thyroid disease in adults. Ann Surg. 2020;271(3):399-410. PMID: 32079828 pubmed.ncbi.nlm.nih.gov/32079828/.

Ullmann T, Kim J, Lindeman B, Sosa JA. The thyroid. In: Tyler DS, Hayes-Dixon A, Hines OJ, et al, eds. Sabiston Textbook of Surgery. 22nd ed. Philadelphia, PA : Elsevier; 2026:chap 73.

Updated by: Ann M. Rogers, MD, FACS, Professor Emeritus, Department of Surgery, Penn State College of Medicine, Hershey, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.