Lan developed a goiter 20 years ago and was advised to have surgery, but she declined. Six months ago, the goiter began to grow, so she took traditional medicine in Lam Dong (formerly Binh Thuan) twice a week for two weeks. When the goiter didn't shrink, she went to Dong Thap and bought herbal leaves to apply to her neck, hoping to eliminate the growth. However, the leaves caused burns and blisters, requiring over a month of treatment.

Recently, she experienced difficulty breathing. A CT scan at Tam Anh General Hospital in Ho Chi Minh City revealed a hand-span-long goiter, about 12 cm wide, extending into her mediastinum (the space between the lungs), compressing her esophagus.

On 9/7, Dr. Doan Minh Trong, from the Breast - Head and Neck Surgery Department, stated that Lan's goiter had grown and descended deep into her mediastinum, requiring surgery. However, its deep position would make the procedure complex.

Dr. Trong explained that sawing through the breastbone, a potential approach, carries risks of significant pain, bleeding, nerve damage, breathing difficulties, and postoperative infection, with a long recovery time. However, during the operation, the surgical team successfully separated the nerves from the goiter and carefully removed it without having to saw through the breastbone.

Dr. Trong and the surgical team operating on Lan. Photo: Tam Anh General Hospital

Dr. Trong and the surgical team operating on Lan. Photo: Tam Anh General Hospital

A substernal goiter occurs when a goiter grows beyond the neck and extends into the mediastinum. Factors like gravity, the force of swallowing, negative pressure in the mediastinum during inhalation, a short cervical trachea, strong neck muscles, and a short neck can contribute to this downward movement.

Dr. Trong noted that substernal goiters account for 3-20% of all goiters and are more common in women, especially those over 50. Most substernal goiters are benign and don't affect health or daily life. However, large goiters can compress the esophagus, trachea, and blood vessels, causing difficulty swallowing, breathing problems, and voice changes. Surgery is the primary treatment for substernal goiters, aiming to remove the entire goiter, alleviate symptoms, and prevent severe compression and respiratory issues.

Dr. Trong advises patients with goiters to follow medical advice. There is no evidence that herbal remedies or traditional medicine can eliminate goiters. Some goiters, like Lan's, extend into the mediastinum and become less palpable, leading patients to mistakenly believe that herbal treatments have dissolved them.

Incorrect treatment is costly and ineffective. Large goiters can cause breathing difficulties, trouble swallowing, chest tightness, and voice changes, potentially leading to acute respiratory failure. The larger the goiter, the more difficult the surgery.

Nguyen Tram

*The patient's name has been changed.