A Retrosternal Goiter

Abstract

An 80 year old lady was evaluated for chronic cough with breathlessness of 5 years duration. She was on multiple medications for the same with little benefit. She has been hypertensive and is controlled with Amlodipine 5 mg daily. No family history of diabetes mellitus, cardiac or thyroid disease and not on any other medication. Physical examination revealed grade I goiter more on left side. No cervical lymphadenopathy. Thyroid function test  revealed Serum total tri-iodothyronine-109.71 ng/dl, total thyroxin-10.92 ng/dl and TSH- 0.27 UI u/ml. ECG was normal. X-ray Chest PA View showed a right paratracheal non-homogenous opacity (Figure 1). CT Thorax showed  retrosternal right paratracheal extension of right lobe of bulky thyroid reaching upto the inferior border of aortic arch with multinodular changes in the thyroid gland. No significant mediastinal lymphadenopathy noted (Figure 2). She was advised Thyroidectomy by Endocrine surgeon for which she was reluctant. She was treated  symptomatically and advised follow-up.