Asthma or Airway Obstruction? A Case of Substernal Goiter Presenting in Pregnancy
Recommended Citation
Nakdali R, Ladzinski A, Hashmi M, Kapadia DV. Asthma or Airway Obstruction? A Case of Substernal Goiter Presenting in Pregnancy. Am J Respir Crit Care Med 2025; 211:A6225.
Document Type
Conference Proceeding
Publication Date
5-20-2025
Publication Title
Am J Respir Crit Care Med
Abstract
Introduction: A thyroid goiter, particularly a substernal goiter, can cause significant airway obstruction, which requires prompt management. In this case, we present a patient who initially presented as an asthma exacerbation with wheezing and was found to have a large thyroid goiter extending into the mediastinum and causing external compression of the trachea. Case Report: A 38-year-old female with a medical history of chronic hypertension with superimposed preeclampsia requiring C-section and asthma presented to the hospital at 36 weeks pregnant due to a 2-month history of shortness of breath with multiple emergency room visits, attributed to asthma exacerbations. During this presentation, she developed respiratory distress, requiring intubation in the emergency room. She was initially treated for an asthma exacerbation along with pre-eclampsia however due to concern for pulmonary embolism, she underwent a computed tomography (CT) scan which showed a large middle mediastinal mass causing mass effect on the esophagus and severe mass effect at the level of the carina. The mass measured 3.8 cm in the axial direction and 9 cm in the craniocaudal direction and extended out of the field of view of the CT scan. She underwent a rigid bronchoscopy with biopsy of the mediastinal mass followed by a C-section. Biopsy revealed thyroid follicular cells. Repeat bronchoscopy showed extrinsic compression of the trachea down to the main carina, with narrowing in the proximal (30%), mid (80%), and distal trachea (90%). She underwent placement of a metal self-expanding stent in the distal trachea as a silicone Y-stent could not be placed due to significant posterior extrinsic compression of the trachea preventing safe advancement of the rigid bronchoscope. Nuclear thyroid scan confirmed uptake throughout mediastinal mass contiguous with thyroid gland suggestive of substernal goiter. Thyroid labs were normal. The patient underwent hemi-thyroidectomy with pathological evaluation of resected mass showing a multinodular thyroid goiter. With relief of her tracheal obstruction, the patient subsequently underwent removal of her tracheal stent without complication a few weeks later. Conclusion: Several studies have suggested that pregnancy can increase the size of a thyroid goiter or pre-existing thyroid nodules. Substernal thyroid goiters can cause significant airway obstruction due to size which can be life threatening. Our patient presented several times for shortness of breath, which was attributed to asthma however recurrent "exacerbations" despite optimal medical therapy in patients should always prompt further investigations for other causes.
Volume
211
First Page
A6225
