Abstract
Here, we present the case of a giant multinodular goiter with retrosternal extension in an old lady with dyspnea for 3 months. The patient was treated with microscopic‐assisted total thyroidectomy without any postoperative complications.
Keywords: giant multinodular goiter, microscopic‐assisted total thyroidectomy, village
Painless huge midline neck mass. Thyroid function test, USG Neck, FNAC and CECT. Microscopic assisted total thyroidectomy if suspicious or proven malignancy and mass effects.
1. CASE REPORT
A 67‐year‐old woman presented at the health camp organized in the Kihun village by Bhawana Foundation, Nepal, with complaints of painless neck swelling for 24 years and shortness of breath for 3 months. Shortness of breath was gradually progressive and aggravated while sleeping in supine position. On neck examination, a large left greater than right mass was present. The mass was non‐tender, non‐pulsatile, and moved with deglutition (Figure 1).
FIGURE 1.
Showing neck mass in the anterior aspect of the neck
Thyroid function tests and serum calcium were within normal limits. Ultrasound of the neck showed multiple thyroid nodules and cystic lesions. The CECT neck revealed heterogeneously enhancing lesions extending retrosternally (Figure 2A,B). FNAC was suggestive of atypia of undetermined significance.
FIGURE 2.
CECT neck coronal view (A) showing heterogeneous mass involving both the lobes of thyroid with retrosternal extension and splaying brachiocephalic vein. (Red arrow) Sagittal view (B) showing mass from sternum to mandible and compressing airway.(Yellow arrow)
The patient underwent microscopic‐assisted total thyroidectomy under general anesthesia. Her postoperative recovery was uneventful and relieved her shortness of breath. The patient was discharged on the sixth postoperative day with levothyroxine replacement therapy. The mass removed from the neck weighed 461.5 g and measured approximately 14 cm (Figure 3). Microscopic examination was consistent with multinodular goiter.
FIGURE 3.
Gross (A) and microscopic (B) feature of excise thyroid mass suggestive of multinodular goiter
Benign multinodular goiter leading to airway compromise has become a rare clinical entity. 1 Universal salt iodization, cosmetic concern, and improved surgical technique with minimal disfigurement have led to the disappearance of large goiter from modern clinical practice. The definitive management of multinodular goiter includes total thyroidectomy. 2
AUTHOR CONTRIBUTIONS
BS involved in diagnosis, treatment, and conceptualization of study. BS, BN, AP, and PN involved in manuscript preparation, editing, and proofreading of final version of manuscript.
CONFLICT OF INTEREST
We declare no competing interests.
CONSENT
Written informed consent was obtained from the patient to publish this report.
ACKNOWLEDGMENT
None.
Sigdel B, Neupane B, Pokhrel A, Nepali P. Giant multinodular goiter for 24 years; hidden in a village in Western Nepal. Clin Case Rep. 2022;10:e06041. doi: 10.1002/ccr3.6041
DATA AVAILABILITY STATEMENT
Data available on request.
REFERENCES
- 1. Kumar KV, Saini M, Kapoor U, Banga P. Massive multinodular goiter with stridor. Indian J Endocrinol Metab. 2012;16(4):664‐665. doi: 10.4103/2230-8210.98043 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Makay Ö. Less than total thyroidectomy for goiter: when and how? Gland Surg. 2017;6(1):S49‐S58. doi: 10.21037/gs.2017.10.02 [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data available on request.