Large substernal thyroid goiter associated with saddle pulmonary embolism

A 75-year-old woman with a longstanding history of a substernal thyroid goiter presented with acute shortness of breath, and she was intubated due to respiratory distress. Computed tomography (CT) scan revealed a compressive substernal goiter with associated vascular compression, axillosubclavian thrombosis, and saddle pulmonary embolism. Weight-based heparin was immediately administered, and the patient subsequently underwent successful thyroidectomy via a cervical incision. This case report of a rare saddle pulmonary embolism associated with a substernal thyroid goiter underscores the importance of early elective thyroidectomy. Successful management of these potentially devastating pulmonary emboli (PE) associated with large substernal goiters is possible.