Challenges in the management of a secondary retrosternal goitre with superior vena cava syndrome

Retrosternal or substernal goitre is a clinical entity defined when a significant proportion of the thyroid gland extends inferiorly through the thoracic inlet into the mediastinum. It has an incidence of 5.1-15.7%, with a female predominance. The clinical course can be indolent without any symptoms or may present as an emergency with compression features of breathlessness, hoarseness of voice, facial oedema, dysphagia and stridor. Definitive management is surgery. We report a case of an elderly woman who presented in the emergency at our tertiary care hospital with superior vena cava syndrome due to a large retrosternal goitre, along with concomitant comorbidities such as obesity, hypertension, atrial fibrillation and severe pulmonary hypertension with pericardial effusion, which posed a significant risk and added complexity to her management.