Pemberton’s Sign in a Patient with a Goiter

This article is an answer to the Case – Reversible Facial Congestion After Elevation of Both Arms

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 and a patent trachea that deviated to the left.

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.


  1. Daniel Hofstedt, Ghassan H Elkadi, Ayça Özbek Özütemiz, Can Özütemiz. (2022) Images in Vascular Medicine: Radiologic confirmation of Pemberton’s sign. Vascular Medicine 27:5, 513-514.
  2. H. Holzgreve. (2018) Beim Kommando „Hände hoch!“ schwillt ihm der Kopf. MMW – Fortschritte der Medizin 160:16, 34-34.