Giant and substernal (retrosternal) goiter represents one of the most anatomically complex, physiologically disruptive, and technically demanding pathologies in contemporary endocrine, head and neck, and thoracic surgery. By definition, the condition refers to a massive enlargement of the thyroid gland that exceeds 250 to 500 grams in weight or demonstrates significant intrathoracic extension below the thoracic inlet, typically with more than 50% of the glandular volume residing within the mediastinum.¹ Unlike ordinary cervical goiters, which remain unconfined anteriorly and are frequently asymptomatic or only mildly compressive, substernal extension fundamentally transforms the thyroid into a true compressive mediastinal mass.¹ This mass becomes inexorably wedged within the rigid, unyielding confines of the superior thoracic aperture, leading to intimate and dense adherence to critical structures, including the trachea, esophagus, recurrent laryngeal nerves, carotid sheath, innominate vein, aortic arch, and superior vena cava.⁴

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Mercante, G., Gabrielli, E., Pedroni, C., Formisano, D., Bertolini, L., Nicoli, F., & Deganello, A. (2011). CT cross-sectional imaging classification system for substernal goiter based on risk factors for an extracervical surgical approach. Head & Neck, 33(6), 792–799. https://doi.org/10.1002/hed.21536

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White, M. L., Doherty, G. M., & Gauger, P. G. (2008). Evidence-based surgical management of substernal goiter. World Journal of Surgery, 32(7), 1285–1300. https://doi.org/10.1007/s00268-008-9485-2

Rugiu, M. G., & Piemonte, M. (2009). Surgical approach to retrosternal goitre: Do we still need sternotomy? Acta Otorhinolaryngologica Italica, 29(6), 331–338.

Shen, W. T., Kebebew, E., Duh, Q. Y., & Clark, O. H. (2004). Predictors of sternotomy in patients with substernal goiter. Archives of Surgery, 139(6), 656–660. https://doi.org/10.1001/archsurg.139.6.656

Sancho, J. J., Kraimps, J. L., Sanchez-Blanco, J. M., et al. (2012). Increased incidence of thyroid cancer in patients with intrathoracic goiter. Archives of Surgery, 147(7), 662–667.

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Raffaelli, M., De Crea, C., Bellantone, R., et al. (2011). Substernal goiters: Incidence, surgical approach, and complications. American Journal of Surgery, 201(3), 356–361.

Testini, M., Gurrado, A., Avenia, N., et al. (2011). Does mediastinal extension of goiter increase morbidity of thyroid surgery? BMC Surgery, 11, 20. https://doi.org/10.1186/1471-2482-11-20

De Perrot, M., Fadel, E., Mercier, O., et al. (2007). Surgical management of mediastinal goiters. Annals of Thoracic Surgery, 83(6), 2011–2015.

Shen, W. T., Kebebew, E., Duh, Q. Y., et al. (2007). Reoperative thyroid surgery for substernal goiter. World Journal of Surgery, 31(3), 575–580.