Retrosternal Goitre Masquerading as Obstructive Sleep Apnoea in a Middleaged Female

Abstract

PRESENTATION OF CASE Retrosternal goitre grows in a tight compartment between the sternum anteriorly and vertebra posteriorly and are symptomatic due to compression of airway and great vessels. The presence of RSG is, per se, an indication for surgical management. Surgery can most commonly be performed using the cervical access, but at times, a sternotomy or thoracotomy is necessary. The challenges encountered by the anaesthetist and the surgeon are-difficulty in intubation/ventilation due to compression of airways, hypervascularity and the proximity of the goitre to great vessels. We report a case of a large RSG in a middle-aged obese female who was on CPAP treatment from a physician for the symptoms of obstructive sleep apnoea for 2 years, but with no relief. There was no visible or palpable neck swelling. CECT neck and chest was done in view of worsening of symptoms, which showed heterogenous enhancing mass in superior mediastinum up to carina likely lymph node mass or exophyti thyroid mass after, which she was referred to Surgery Department. Ultrasound findings also suggested colloid goitre of both the lobes and swelling of isthmus, which was continuous with the retrosternal mass. FNAC proved it to be colloid goitre with cystic degeneration. She was euthyroid as per laboratory parameters. Patient was operated by transcervical approach and near total thyroidectomy was performed. Patient was discharged in satisfactory condition. A high index of suspicion for the presence of retrosternal goitre should always be kept in mind in endemic areas of goitre in patient of obstructive sleep apnoea, which is refractory to medical management.