Illustration of a retrosternal goiter compressing the superior vena cava.

Choking Hazard: How a Hidden Goiter Almost Cut Off This Woman's Air Supply

Kai Mendoza in Health & Wellness November 2025 • 4 min read.

"A rare case highlights the dangers of retrosternal goiters and the importance of timely intervention to prevent life-threatening complications."

Imagine struggling to breathe, your neck swelling as if something is trying to choke you from the inside. This was the reality for a 50-year-old woman who walked into West Middlesex University Hospital in London. Her symptoms had been worsening for four weeks, leaving her gasping for air.

Doctors noted her neck swelling and performed a Pemberton's sign test. This test involves raising the arms, which, in her case, obstructed the thoracic inlet (the opening at the top of the chest), leading to facial plethora – a flushed, congested appearance of the face. It was clear something serious was happening.

A computed tomography (CT) scan of her neck revealed the shocking truth: a large retrosternal goiter was compressing her superior vena cava (SVCO), the major vein carrying blood from the upper body to the heart. This obstruction was causing her breathing difficulties and other symptoms.

What is a Retrosternal Goiter and Why is it Dangerous?

Illustration of a retrosternal goiter compressing the superior vena cava.

A goiter, simply put, is an enlargement of the thyroid gland. The thyroid, located in the neck, produces hormones that regulate metabolism. While goiters are often benign, they can cause problems when they grow too large and compress nearby structures.

A retrosternal goiter is a goiter that extends down into the chest, behind the breastbone (sternum). These goiters can be particularly dangerous because they can compress the trachea (windpipe), esophagus (food pipe), and major blood vessels in the chest, like the superior vena cava. This compression can lead to a variety of symptoms, including:

Difficulty breathing (dyspnea)
Swelling of the neck
Difficulty swallowing (dysphagia)
Coughing
Hoarseness
Superior vena cava syndrome (SVCS)

In this woman's case, the retrosternal goiter was causing superior vena cava obstruction (SVCO). SVCS is a serious condition that occurs when the superior vena cava is blocked, preventing blood from flowing properly back to the heart. This can lead to swelling of the face, neck, and arms, as well as shortness of breath and chest pain. If left untreated, SVCS can be life-threatening.

The Road to Recovery

The woman was treated with 40 mg of prednisolone (a steroid medication to reduce inflammation) and underwent a thyroidectomy to remove the goiter. Histology (microscopic examination) of the removed tissue revealed a 333g benign multi-nodular goiter. After the operation, her symptoms resolved, and she was able to breathe freely again.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1136/bmj.k4331, Alternate LINK

Title: Extended Retrosternal Goitre With Superior Vena Cava Obstruction

Subject: General Engineering

Journal: BMJ

Publisher: BMJ

Authors: Talisa Ross, Carole Collins

Published: 2018-10-24

Everything You Need To Know

What is a retrosternal goiter?

A retrosternal goiter is an enlargement of the thyroid gland that extends down into the chest, specifically behind the breastbone (sternum). These goiters are concerning because they can compress vital structures such as the trachea, esophagus, and major blood vessels like the superior vena cava, potentially leading to severe symptoms.

What are the symptoms of a retrosternal goiter?

Retrosternal goiters can cause a range of symptoms due to their compression of nearby structures. These include difficulty breathing (dyspnea), swelling of the neck, difficulty swallowing (dysphagia), coughing, hoarseness, and potentially leading to superior vena cava syndrome (SVCS). The severity of these symptoms can vary depending on the size and location of the goiter and the extent of compression.

How can a retrosternal goiter cause breathing difficulties?

Breathing difficulties arise when a retrosternal goiter compresses the trachea (windpipe). The trachea is the primary pathway for air to travel to and from the lungs. When the goiter presses on the trachea, it narrows the airway, making it harder to breathe. This can lead to shortness of breath and a feeling of being suffocated, as experienced by the woman in the case mentioned.

Why is a superior vena cava obstruction (SVCO) a serious complication of a retrosternal goiter?

Superior vena cava obstruction (SVCO) is a serious complication because the superior vena cava is a major vein that carries blood from the upper body to the heart. When a retrosternal goiter compresses and obstructs the superior vena cava, it prevents blood from flowing properly back to the heart. This can lead to a buildup of blood and cause swelling of the face, neck, and arms, as well as shortness of breath and chest pain. If untreated, SVCO can become life-threatening.

How is a retrosternal goiter treated?

The primary treatment for a retrosternal goiter is often a thyroidectomy, which is a surgical procedure to remove the goiter. In the case described, the woman also received prednisolone, a steroid medication, to reduce inflammation. The specific approach depends on the size of the goiter, the severity of the symptoms, and the overall health of the patient. After removing the retrosternal goiter, symptoms such as breathing difficulties typically resolve, as demonstrated in this scenario.