Case report of toxic multinodular goiter with neck compression

We present a case of a 62-year-old patient with multinodular substernal goiter and tracheal compression (up to 5 mm). The multinodular goiter was initially diagnosed 3 years before by a local endocrinologist. The patient had been suffering from difficulty of breathing and exertional dyspnea for two years. He consulted specialists in therapy, pulmonology, cardiology more than once. However, none of the clinicians was able to identify the cause of labored respiration. Eventually an endocrine surgeon diagnosed a case of the complicated multinodular goiter with the development of cervical compression syndrome and tracheal narrowing.

Ultrasound study showed the diffuse enlargement of the thyroid gland mainly due to the large left lobe with a total volume of 132,5 cm3. Computed tomography showed the shift of trachea to the right because of its compression by the left lobe and the luminal narrowing up to 5 mm. The patient needed surgical intervention by life-saving indications. He underwent thyroidectomy. The postoperative period was uneventful, the patient did not complain about labored respiration and reported the improvement of physical activity. It is important to keep in mind that patients with multinodular goiter have the potential risk of developing cervical compression syndrome. Current case demonstrates that such patients should be examined by an endocrine surgeon as early as possible in order to perform timely elective surgery.

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