43 Y/O F one month right arm and shoulder pain with weakness and tingling in the arm.She had no neck symptoms and no enlarged thyroid gland in the neck area.
X Ray of the shoulder showed a mass in the chest by arrow.
CT imaging 12 cm mass in the superior mediastinum by arrow.
Compression of vital structures seen.
PE Pain with the raising of the arm above head ( Neer Test).
Ct guided FNA diagnosis was a benign class II nodule.
Primary Goiters in the chest <1.0% of these are completely separate from the thyroid gland in the neck while secondary are connected to the thyroid gland in the neck 6%. These can be asymptomatic for years as they grow larger.When try compress the brachial plexus there is pain and weakness this is called Thoracic Outlet Syndrome TOS.
Chest surgery is needed. Complete removal of the multinodular goiter. Final DX Benign Goiter with Hurthle cell changes.
She had complete relief of her symptoms.
Extremely rare case.
Gettle el al Endocrine practice 25(1) Jan.2019 p.117.