Enormous disfiguring thyroid swelling

A 35 year old woman presented to us with a huge thyroid swelling (17 × 11 × 14 cm) in front of her neck which she had for the last 10 years. She was not toxic or dyspnoeic. It was multinodular with areas of firmness and cystic feeling. She had some degree of tracheal compression but no intra thoracic extension as confirmed by a CT scan of the neck. Endotracheal intubaton was done and she was operated on using a long transverse incision with division of the strap muscles for better exposure. She did not need a tracheostomy and the post operative period was uneventful. The histopathological revealed a goitre.