Giulea C, Enciu O, Nadragea M, Badiu C, Miron A
"Carol Davila" University of Medicine and Pharmacy, Dept. of Surgery, Bucharest, Romania.
Elias University Emergency Hospital, Dept. of Surgery, Bucharest, Romania.
Acta Endocrinol (Buchar). 2016 Apr-Jun;12(2):227-229. doi: 10.4183/aeb.2016.227.
Retrosternal goitre enlargement can cause compression of several mediastinal structures, especially the trachea and the superior vena cava. Retrosternal goitre as a cause of superior vena cava syndrome is a rare occurrence. We report the case of a middle aged man that underwent surgery for retrosternal goitre with compression of both innominate veins presenting as superior vena cava syndrome.
A 50 year old man presented with a 2 year history of cyanosis of the upper limbs, head and neck, marked facial edema, plethora, dyspnea on exertion and choking sensation. Pemberton's sign was present. Computer tomography diagnosed retrosternal goitre at the level of the aortic arch, tracheal compression and important collateral circulation. Endocrine evaluation showed normal thyroid function (fT4 15.8 pmol/L) with low-normal TSH (0.5mU/L), normal calcitonin (<2 pg/mL). The patient underwent successful total thyroidectomy with cervical approach and his symptoms dramatically improved. The facial oedema persisted for the next 3 weeks.
Less than 3% of superior vena cava syndromes are secondary to a variety of benign causes. Superior vena cava syndrome caused by slow growing retrosternal goitres is very rare and can be asymptomatic for a long period due to venous collateral development.
Superior vena cava syndrome secondary to retrosternal goitres, a very rare occurrence, is an indication for total thyroidectomy, with low postoperative morbidity and dramatic resolution of symptoms.
胸骨后甲状腺肿增大可导致多个纵隔结构受压，尤其是气管和上腔静脉。胸骨后甲状腺肿作为上腔静脉综合征的病因较为罕见。我们报告一例中年男性患者，因胸骨后甲状腺肿压迫无名静脉导致上腔静脉综合征而接受手术治疗。
一名50岁男性，有上肢、头颈部发绀2年病史，伴有明显面部水肿、充血、劳力性呼吸困难和哽咽感。存在彭伯顿征。计算机断层扫描诊断为主动脉弓水平的胸骨后甲状腺肿、气管受压及重要的侧支循环。内分泌评估显示甲状腺功能正常（游离甲状腺素15.8 pmol/L），促甲状腺激素略低于正常（0.5 mU/L），降钙素正常（<2 pg/mL）。患者经颈部入路成功进行了全甲状腺切除术，症状显著改善。面部水肿在接下来的3周内持续存在。
不到3%的上腔静脉综合征继发于各种良性病因。由生长缓慢的胸骨后甲状腺肿引起的上腔静脉综合征非常罕见，由于静脉侧支循环的发展，可能长期无症状。
胸骨后甲状腺肿继发的上腔静脉综合征极为罕见，是全甲状腺切除术的指征，术后发病率低，症状可显著缓解。
