Multidisciplinary Management of Airway Obstruction and Superior Vena Cava Obstruction Secondary to Huge Retrosternal Goiter

Chen Yc,Ikhwan Sm

doi:10.7438/1584-9341-10-2-18

Abstract

Airway obstruction and superior vena cava syndrome (SVC) secondary to huge retrosternal goiter are medical emergencies which need meticulous attention to prevent potentially life threatening events. We reported a case of huge retrosternal goiter which was neglected for years and later complicated by obstruction to airway and superior vena cava. Team effort which mainly involved endocrine surgeon, cardiothoracic surgeon and anaesthetist had successfully removed the gland without significa t morbidity. He was on tracheostomy due to tracheomalacia and was managed by ENT surgeon. He was discharged well after 2 weeks.

Highlights

Retrosternal goiter is defined as more than 50% of thyroid gland descends in the thorax [1]
An identified retrosternal goiter is an absolute indication for surgery
On current examination there was multinodular swelling at anterior neck, firm in consistency with retrosternal extension and presence of dilated vein. He was admitted to ICU and treated as airway and SVC obstruction secondary to huge retrosternal goiter with concurrent severe community acquired pneumonia

Summary

Introduction

Retrosternal goiter is defined as more than 50% of thyroid gland descends in the thorax [1]. A 61-year-old gentleman, known case of advanced follicular thyroid cancer for 10 years, presented with progressively worsening shortness of breath and altered consciousness associated with fever for 3 days prior to admission. On current examination there was multinodular swelling at anterior neck, firm in consistency with retrosternal extension and presence of dilated vein. He was admitted to ICU and treated as airway and SVC obstruction secondary to huge retrosternal goiter with concurrent severe community acquired pneumonia. He was further referred to Oncologist for Radioactive Iodine Therapy

Discussion

Findings

Conclusion