title: Phrenic Nerve Palsy as Initial Presentation of Large Retrosternal Goitre.
abstract: Unilateral phrenic nerve palsy as initial presentation of the retrosternal goitre is extremely rare event. This is a case report of a 57-year-old woman with history of cough and breathlessness of 3 months duration, unaware of the thyroid mass. She had large cervico-mediastinal goiter and chest radiograph revealed raised left sided hemidiaphragm. Chest CT scan did not reveal any lung parenchymal or mediastinal pathology. The patient underwent a total thyroidectomy through a cervical approach. The final pathology was in favor of multinodular goitre. Even after 1 year of follow up, phrenic nerve palsy did not improve indicating permanent damage. Phrenic nerve palsy as initial presentation of the retrosternal goitre is unusual event. This case is reported not only because of the rare nature of presentation, but also to make clinicians aware of the entity so that early intervention may prevent attendant morbidity.
authors.affiliation: Department of head and neck Oncology, Apollo cancer Hospitals, Jubilee Hills, Hyderabad, Telangana India 500096.
authors.forename: Arsheed Hussain
authors.initials: AH
authors.lastname: Hakeem
authors.affiliation: Department of Internal Medicine, Poplar Bluff regional medical Center, Poplar Bluff, MO USA.
authors.forename: Imtiyaz Hussain
authors.initials: IH
authors.lastname: Hakeem
authors.affiliation: Department of Obstetrics and gynaecology, Apollo Hospital, Jubilee Hills, Hyderabad, Telangana India 500096.
authors.forename: Fozia Jeelani
authors.initials: FJ
authors.lastname: Wani
keywords: Complications; Phrenic nerve palsy; Raised hemi diaphragm; Retrosternal goitre; Thyroidectomy