Anatomical Predictors of Aerodigestive Symptoms in Substernal Goiters

Background Substernal goiters can cause aerodigestive symptoms but are often asymptomatic. This study evaluated the relationship between symptoms, demographics, pathology, and anatomical severity in substernal goiter patients using standardized tools. Methods A retrospective review of 201 patients surgically treated for substernal goiters over 11 years at a quaternary‐care center was conducted. CT scan images were analyzed to measure tracheal deviation (TD), compression (TC), and depth. Symptoms included dysphagia, dyspnea, dysphonia, and coughing. Associations with demographics, anatomy, and pathology were analyzed. Results Dysphagia was the most common symptom (48.8%); 27% were asymptomatic. TC and larger specimen weights were significantly associated with dyspnea ( p < 0.001, 0.013). TD, depth, age, and BMI showed no significant correlation with symptoms. Cough and vocal cord dysfunction were linked to aggressive pathology ( p = 0.003, 0.017). Conclusion CT imaging is essential in evaluating substernal goiters, as symptoms alone are insufficient. Symptom profiles may also aid in predicting pathological severity.