Systematic review of benign thyroid enlargement as a rare cause of arterial compression: clinical presentations and...

The objective of this study is to systematically characterize the presentation, management, and outcomes of arterial complications secondary to benign thyroid enlargement, thereby improving clinical recognition and management of this rare entity. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across PubMed, Web of Science, Embase, and Scopus for studies published from January 1990 to February 2026. This review was registered with PROSPERO CRD420251156228. Studies describing arterial compression, displacement, stenosis, or occlusion attributable to benign thyroid pathology were included. Ten studies met the inclusion criteria, comprising 10 patients with a median age of 66 years, of whom 80% were female. Six patients presented with acute neurologic symptoms, including limb-shaking episodes and lateralized weakness, while the remainder exhibited subacute or chronic compressive complaints. Computed tomography with or without angiography was the primary diagnostic modality. The common carotid artery was involved in nine patients, including bilateral compression in two patients. Multinodular goiter was the most common pathology, with goiter sizes reaching up to 15 cm. Surgical management via thyroidectomy was performed in five patients, while the others were managed conservatively. Follow-up was documented in only five of the ten patients; in each of these, symptoms resolved without reported recurrence, while the remaining five reports contained no post-treatment follow-up data. In conclusion, benign thyroid enlargement is a rare but clinically significant cause of cervical arterial compression that can precipitate neurologic symptoms mimicking cerebrovascular disease. Cross-sectional imaging is essential for diagnosis, and both surgical decompression and conservative strategies were followed by symptom resolution in the cases with documented follow-up. Because the evidence base comprises ten single-patient reports with incomplete follow-up, no objective outcome measures, and no comparative data, certainty of evidence is very low, and these findings should be regarded as hypothesis-generating rather than as guidance for management.