Horner's syndrome, substernal goiter

[lizyorke]

Hi, I was diagnosed last February as having a very large Hashimoto's goiter with right ipsilateral Horner's syndrome. I have always had asthma and two months before before this was diagnosed I had several episodes of respiratory distress where I was nearly hospitalized -I wanted to be treated at home with prednisone and nebulizer. CT scan shows that though I have a patent airway, I am hoarse, my trachea is pearshaped and the thyroid is extending deep into the superior mediastinum on the right side. My right trapesius muscle is often in spasm, I have tension headaches on the right side and I have pain in my right shoulder. I have been referred to Yale Medical center to see Professor  Robert Lesser who is, I understand, an expert in neuro-opthalmology.  I am aware that pressure on the nerve of he eye is the issue of concern and that this will be gradually increasing.  I am also aware that delay in getting surgery done can add to the difficulty and complexity of the task. I have already had three months of testing and referrals, since the Horners began. Any surgery planned will take time to be set up. My question is - should I wait for this consult in two months time, or should I push for more immediate surgery-hoping thereby to avoid further damage to the nerve and to my lungs, trachea and larynx. I am interested in hearing of treatment options, risks, benefits and possible outcomes, especially as far as the Horners syndrome is concerned - Any advice will be welcome!

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[Mark Lupo, M.D.]

If there is evidence of nerve compression due to goiter, then surgery is the best option.  After surgery you will need thyroid replacement medications (if not already on).  In expert hands, the risks of surgery are minimal.  I am not sure what an ophthalmologist will add in this situation.