A huge forgotten retrosternal goiter causing a superior vena cava syndrome after 20 years of thyroidectomy: A case report

Introduction

Retrosternal goiters are thyroid enlargements that extend into the mediastinum and may compress adjacent structures. Although uncommon, residual thyroid tissue after total thyroidectomy can remain asymptomatic for years and present later with serious complications such as superior vena cava (SVC) syndrome.

Case presentation

A 51-year-old woman presented with progressive facial swelling, neck vein distension, and dyspnea. She had undergone total thyroidectomy 20 years prior for multinodular goiter. Physical examination revealed facial plethora and a positive Pemberton's sign. CT imaging demonstrated a large heterogeneous mediastinal mass compressing the SVC and deviating the trachea, consistent with a retrosternal goiter. The mass was excised through a cervical approach. Histopathology confirmed benign nodular thyroid tissue. The patient had full resolution of symptoms postoperatively.

Discussion

This case highlights a rare but significant delayed complication of thyroidectomy. Despite previous total thyroidectomy, remnant or ectopic thyroid tissue can persist and enlarge silently over decades. Clinical clues such as Pemberton's sign are essential in recognizing thoracic inlet obstruction. Imaging confirms diagnosis and aids surgical planning. While SVC syndrome is often associated with malignancy, benign causes like substernal goiter must remain in the differential, especially in patients with thyroid surgery history.

Conclusion

Forgotten retrosternal goiters may present decades after thyroidectomy with life-threatening complications like SVC syndrome. Awareness of this entity, combined with careful clinical assessment and imaging, is critical to timely diagnosis and effective, minimally invasive surgical management.