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Substernal multinodular goiter resulting in superior vena cava syndrome and tracheal compression
  1. Adrianna Gorniak1,
  2. Philip Carlson-Dexter1,
  3. Joana Ochoa2 and
  4. Annette Carmichael1,3
  1. 1Family and Community Medicine, UIC College of Medicine - Rockford, Rockford, Illinois, USA
  2. 2University of Florida Health at Jacksonville, Jacksonville, Florida, USA
  3. 3Pharmacy Practice, UIC College of Pharmacy - Rockford, Rockford, Illinois, USA
  1. Correspondence to Dr Annette Carmichael; aprove2{at}


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.

  • Thyroid disease
  • Otolaryngology / ENT

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  • Contributors AG contributed to the design of the manuscript, collecting the information and drafting the article. JO contributed to the essential care and description of the patient, collecting the information and drafting the article. PC-D contributed to the essential care of the patient, design of the manuscript, collecting the information and drafting the article. AHC contributed to the design of the manuscript, collecting the information, drafting the article and preparing the article for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.