Pemberton’s Sign in a Patient with a Goiter
A 77-year-old man was referred to the endocrinology clinic for the evaluation of subclinical hyperthyroidism. He had no symptoms of thyrotoxicosis and no dyspnea or dysphonia that would suggest tracheal compression. Physical examination revealed an enlarged thyroid with no palpable nodules or cervical lymphadenopathy (Panel A). Pemberton’s sign — reversible facial congestion after elevation of both arms — was noted. The plasma thyrotropin level was 0.2 mIU per liter (reference range, 0.4 to 4.4), and the serum level of free thyroxine was normal. Computed tomography of the neck revealed an enlarged thyroid that was compressing the subclavian and jugular veins (Panel C) and a patent trachea that deviated to the left (Panel C, arrow). Pemberton’s sign is indicative of superior vena cava syndrome due to obstruction of the thoracic inlet. The patient underwent an uncomplicated total thyroidectomy, and a benign goiter was observed on pathological analysis. Thyroid hormone therapy was prescribed, and the patient was euthyroid on follow-up 6 months after surgery.