A patient with a large thyroid goiter may develop thoracic outlet obstruction.


Features of the thyroid goiter:

(1) large and multinodular

(2) presence of retrosternal extension into the anterior superior mediastinum


Clinical features:

(1) dyspnea on exertion

(2) intermittent stridor

(3) choking sensation while recumbent

(4) facial plethora (Pemberton's sign) if both arms are held overhead (Pemberton's maneuver)


The respiratory symptoms are associated with tracheal deviation and/or compression.


The facial congestion when both arms are held overhead is due to:

(1) upward movement of the thoracic outlet against the thyroid goiter

(2) compression of the jugular veins against the goiter


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