An Unusual Case of Dyspnea: Substernal Goiter

Abstract

Introduction: Substernal thyroid goiter is defined as extension of the thyroid gland into the mediastinum. Vocal cord paralysis, vena cava superior syndrome due to the compression on major vessels, and Horner syndrome can be rarely seen in patients. Case Report: A 77-year-old female patient presented to our emergency department with complaints of dyspnea, flushing, and edema on her face. Her vital signs were as follows: BP: 140/90 mm Hg, HR: 135 bpm, respiratory rate: 28 per minute, and SpO2: 88%. On her physical examination, there was increased jugular venous distension, both thyroid lobes were palpable, and breath sounds decreased in the right lung. A contrast-enhanced pulmonary computed tomography (CT) was planned, and substernal goiter was seen on CT. Then, 4 L/min supplemental O2, 2 puffs of 200 mcg budenoside 3 times a day and 250 mg IV methylprednisolone therapy were started. Conclusion: In patients presenting with dyspnea, retrosternal (substernal) goiter should also be considered.