Title: A Rare Case of Sudden Onset of Respiratory Distress Due to a Retrosternal Goiter Presenting to the Emergency Department

Authors: Jitesh Dhingra, Harmeet Rai Singh, Avi Kumar, Mona Sharma

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i6.133

Abstract

Huge cervical and retrosternal goiters can cause acute respiratory compromise by leading to tracheal compression and airway compromise.  

Substernal goiters may be asymptomatic or may present with symptoms caused by compression of adjacent organs. Acute respiratory failure is rare in cases of substernal goiter.

 In cases of symptomatic substernal goiter the treatment is surgical by thyroidectomy. We present a rare case of a giant substernal nontoxic goiter which presented to the emergency department with acute respiratory insufficiency. The patient decided not to get the definitive treatment of thyroidectomy never the less it becomes an extremely important case to discuss to consider this as a probable differential diagnosis in the emergency department, a place where time is the essence of life.

References

  1.      Miller MR, Pincock AC, Oates GD, Wilkinson R, Skene-Smith H. Upper airway obstruction due to goitre: detection, prevalence and results of surgical management. Q J Med. 1990;74:177–88

2.      Ríos A, RodrÍguez JM, Canteras M, Galindo PJ, Tebar FJ, Parrilla P: Surgical management of multinodular goiter with compressive symptoms. Arch Surg. 2005, 140: 49-53. 10.1001/archsurg.140.1.49.31 

3.      Thusoo TK, Gupta U, Kochhar K, Hira HS. Upper airway obstruction in patients with goiter studies by flow volume loops and effect of thyroidectomy. World J Surg. 2000;24:1570–2

4.      Banks C, Ayers C, Hornig J, Lentsch E, Day T, Nguyen S, et al. Thyroid disease and compressive symptoms. Laryngo-scope. 2012;122:13-6 

5.      Jennings A. Evaluation of substernal goiters using computed tomography and MR imaging. Endocrinol Metab Clin North Am. 2001;30:401-14, ix 

6.      Nandwani N, Tidmarsh M, May AE. Retrosternal goitre: a cause of dyspnoea in pregnancy. Int J Obstet Anesth. 1998;7:46–9.

7.      MacK E. Management of patients with substernal goiters. Surg Clin North Am. 1995;75:377-94 

8.      Tsang F, Wan I, Lee T, Ng S, Yim A. Management of retrosternal goitre with superior vena cava obstruction. Heart Lung Circ. 2007;16:312-4 

9.      Rios A, Rodriguez J, Canteras M, Galindo P, Tebar F, Parrilla P. Surgical manage-ment of multinodular goiter with compr-ession symptoms. Arch Surg. 2005;140: 49-53  

10.  Anders H. Compression syndromes caused by substernal goitres. Postgrad Med J. 1998;74:327-9

11.  Gittoes NJL, Miller MR, Daykin J, Sheppard MC & Franklyn JA. Upper airways obstruction in 153 consecutive patients presenting with thyroid enlargement. BMJ 1996 312 484.

12.  Lang BH, Lo CY. Total thyroidectomy for multinodular goiter in the elderly. Am J Surg. 2005;190:418–23. 

13.  Ríos A, Rodríguez JM, Galindo PJ, Canteras M, Parrilla P. Surgical treatment for multinodular goitres in geriatric patients. Langenbecks Arch Surg. 2005;390:236–42. 

Corresponding Author

Jitesh Dhingra

GW Fellow, Moolchand Hospital