Clinical data: A 72-year-old man was referred for evaluation of a suspected goiter. Ha has been treated with lung sarcoidosis for several years. On routine chest X-ray examination, a mass suspicious of a substernal goiter was detected.

Palpation: no abnormality.

Result of blood test: TSH 2.75 mIU/L, aTPO 0.4 U/mL.

Ultrasonography. The thyroid was echonormal. There were no discrete lesions of clinical or oncological significance. The lower pole of the lobes was not visualized in a supine position with the neck stretched backwards low.

Final report. The thyroid is healthy. Substernal spread of clinical importance can be excluded.

Comments.

1. The chest X-ray examination is performed in standing position. A substernal thyroid is quite a common finding in patients, particularly in elderly men. In great proportion of these patients, the lower pole can be visualized neither in supine position. However, if the pole becomes visible during swallowing, then a clinically significant substernal spread can be excluded. If we have any doubt, a neck and upper mediastinal and CT scan will decide the issue.

2. In this patient, the thyroid was decreased in size which stood against the possibility of significant substernal extension. Although the lower pole could not be seen, the lower third of the thyroid gland was visibly thinned which was also against substernal spread of significant degree.