Cough Syncope Secondary to Retrosternal Goiter with Severe Tracheal Deviation: A Case Report and Literature Review

Introduction: Retrosternal goiters are often incidental findings on chest radiography but may progress to cause significant compressive symptoms involving the trachea, esophagus, and great vessels.While dyspnea and dysphagia are common, severe tracheal compression can rarely induce chronic cough, leading to syncope.Case description: We report the case of a 67-year-old morbidly obese female presenting with recurrent syncope triggered exclusively by bouts of dry cough.Despite extensive cardiac and pulmonary evaluations, the etiology remained obscure until a CT angiogram revealed a large retrosternal goiter causing severe tracheal deviation and luminal narrowing.Conclusions: Total thyroidectomy was performed, resulting in immediate cessation of the cough and complete resolution of syncopal episodes.This case underscores the importance of excluding mechanical obstruction in obese patients with tussive syncope.Removal of the compressive mass is curative by eliminating the afferent trigger of the cough reflex.