We present the case of an 82-year-old woman with progressive dyspnea, hoarseness, and dysphagia due to a large substernal multinodular goiter. Ultrasound and CT revealed a predominantly left-lobe intrathoracic goiter with significant tracheal deviation and esophageal compression. Owing to her high surgical risk and the intrathoracic extension of the goiter, selective embolization of the left superior thyroid artery was successfully performed using microspheres. At 12-month follow-up, imaging showed an 87% reduction in goiter volume, accompanied by marked improvement in dyspnea, dysphagia, and hoarseness. This unique case highlights thyroid artery embolization as a minimally invasive and effective alternative for symptomatic substernal goiters in patients unsuitable for surgery and radiofrequency ablation.
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