Your thyroid gland is a butterfly-shaped gland that sits in the front of the neck around your trachea. If your thyroid gland becomes enlarged, a goiter can form in the area. Typically they form outward in the neck region, but in some cases they grow downward towards the chest. These growths are called substernal goiters, and they can cause even more problems that a typical goiter. Today, we explain why substernal goiters develop, and how they are treated.
Why Substernal Goiters Develop
Substernal goiters develop for many of the same reasons that a normal goiter develops. This includes iodine deficiency, thyroid nodule mutations, exposure to radiation or they can be hereditary. Some of these substernal goiters will remain small, and due to their location, they may not be noticed unless they become symptomatic. Others will be very noticeable due to their size alone, and they may be accompanied by the following symptoms:
- Excessive or frequent coughing
- The feeling that something is lodged in your throat
- Difficulty breathing
- Food getting stuck in your throat while eating
- Disrupted sleep or waking in the middle of the night feeling like you can’t breathe
Diagnoses and Treatment of Substernal Goiters
When a substernal goiter develops, it grows downward towards the chest cavity instead of outward in the neck region. This is problematic because the chest area is surrounded by rigid bone structures, and if the substernal goiter grows large enough it will compress the soft tissues near these rigid structures, like your lungs, trachea and blood vessels. Compression of these structures can cause serious problems that deserve immediate attention.
If an endocrine specialist believes you may be suffering from a substernal goiter, they’ll conduct a physical exam and confirm their suspicions with an imaging scan. An x-ray of your chest can help determine if the trachea is being compressed, but a physician may also suggest a CT scan which can produce a better picture of what’s going on inside your body. Once the doctor has determined what structures the goiter has affected, and the best way to attack the problem, they’ll cover your treatment options.
If the goiter is small and non-problematic, treatment may only include medications to maintain adequate iodine levels and regular checkups to ensure it isn’t getting any larger. However, if intervention is needed, surgery will likely be the most common route. Medical science has come a long way in a short amount of time, and although theses goiters may be located around or underneath the sternum, the bone doesn’t need to be broken in order to safely remove the growth. Instead, a surgeon can remove the goiter by putting the patient under anesthesia, tilting their head back and making a small incision on the side of the neck. In rare cases, a sternal splitting operation may be needed, but your doctor will go over all your options prior to the operation.
