Causes of Respiratory Distress Associated with Goiter

Retrosternal extension of thyroid tissue into the mediastinum can cause significant tracheal compression, leading to respiratory distress, as noted by the American College of Radiology 1, 2, 3
Tracheal compression due to goiters can lead to dyspnea, orthopnea, obstructive sleep apnea, and stridor, according to the American College of Radiology 2, 3
Recurrent laryngeal nerve palsy can cause vocal cord dysfunction and some respiratory symptoms, although it is less commonly the primary cause of significant respiratory distress, as reported in the International Journal of Surgery 4
Malignant tracheal invasion, though serious, is less common than mechanical compression from benign goiter extension, as stated by the American College of Radiology 5, 6

Clinical Presentation

Patients with respiratory distress from goiter may present with progressive dyspnea, especially when lying flat, as noted by the American College of Radiology 2
Obstructive sleep apnea symptoms can occur due to tracheal compression from goiters, according to the American College of Radiology 2

Ultrasound is the first-line imaging modality to confirm thyroid origin and characterize goiter morphology, as recommended by the American College of Radiology 2, 3
CT scan is superior for evaluating substernal extension and defining the degree of tracheal compression, and is preferred over MRI due to less respiratory motion artifact, as stated by the American College of Radiology 1, 2, 3
MRI is an alternative to CT but with more respiratory motion artifact, as noted by the American College of Radiology 3, 7

Dysphonia (voice changes) and hoarseness may occur due to nerve injury in some cases, according to the International Journal of Surgery 8
Vocal cord paralysis due to recurrent laryngeal nerve injury is a rare but serious complication 8
Nodule rupture is a rare complication (0.08% to 0.21%) presenting with neck discomfort and swelling 8

CT imaging is superior to ultrasound for evaluating the degree of tracheal compression when respiratory symptoms are present, as recommended by the American College of Radiology 9