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Substernal multinodular goiter resulting in superior vena cava syndrome and tracheal compression. 2023

Adrianna Gorniak, and Philip Carlson-Dexter, and Joana Ochoa, and Annette Carmichael
Family and Community Medicine, UIC College of Medicine - Rockford, Rockford, Illinois, USA.

A woman in her early 70s presented to the family medicine clinic with shortness of breath and an inability to lie flat for several months. When lying flat or on lifting her arms above her head, her face would turn bright red and she felt lightheaded. The patient also had hair loss and skin colour changes of the upper extremities. On examination, the thyroid was palpated and felt normal without enlargement or nodularity. Considering the patient's 70-90 pack-year smoking history, a malignant process of the lung causing superior vena cava syndrome was suspected. CT chest with intravenous contrast revealed a markedly enlarged thyroid with substernal extension of a multinodular goitre producing a mass effect in the upper mediastinum. Thyroid-stimulating hormone was normal. The patient had a total thyroidectomy performed by endocrine surgery. Pathology revealed multinodular hyperplasia and chronic lymphocytic thyroiditis. The patient recovered well postoperatively and her compressive symptoms resolved.

UI MeSH Term Description Entries
D006965 Hyperplasia An increase in the number of cells in a tissue or organ without tumor formation. It differs from HYPERTROPHY, which is an increase in bulk without an increase in the number of cells. Hyperplasias
D006984 Hypertrophy General increase in bulk of a part or organ due to CELL ENLARGEMENT and accumulation of FLUIDS AND SECRETIONS, not due to tumor formation, nor to an increase in the number of cells (HYPERPLASIA). Hypertrophies
D005260 Female Females
D006045 Goiter, Substernal An enlarged THYROID GLAND with at least 50% of the gland situated behind the STERNUM. It is an unusual presentation of an intrathoracic goiter. Substernal goiters frequently cause compression on the TRACHEA leading to deviation, narrowing, and respiratory symptoms. Goiter, Intrathoracic,Intrathoracic Goiter,Substernal Goiter,Goiters, Intrathoracic,Goiters, Substernal,Intrathoracic Goiters,Substernal Goiters
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013479 Superior Vena Cava Syndrome A condition that occurs when the obstruction of the thin-walled SUPERIOR VENA CAVA interrupts blood flow from the head, upper extremities, and thorax to the RIGHT ATRIUM. Obstruction can be caused by NEOPLASMS; THROMBOSIS; ANEURYSM; or external compression. The syndrome is characterized by swelling and/or CYANOSIS of the face, neck, and upper arms which is called Pemberton's sign. Classification of SVC obstruction is often based on COLLATERAL CIRCULATION. Obstruction of the Superior Vena Cava,SVC Obstruction,SVC Syndrome,SVC Thrombosis,Superior Vena Cava Obstruction,Superior Vena Cava Thrombosis,Obstruction, SVC,SVC Obstructions,SVC Syndromes,SVC Thromboses,Syndrome, SVC,Thrombosis, SVC

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