Multinodular benign goitre as an immediate threat to the airway: a case report

Acute upper airway obstruction (AUAO) due to benign thyroid disease is a rare but life-threatening condition. We report a case of an 82-year-old woman with a toxic multinodular goitre who presented to the emergency department with confusion and noisy breathing. Despite being initially stable, she developed progressive stridor and hypoxemia. A neck CT revealed significant tracheal compression due to the goitre. Immediate intubation and corticosteroid treatment were followed by urgent total thyroidectomy and tracheostomy. She was admitted to the ICU for management of laryngeal oedema and rehabilitation. The pathophysiology of AUAO in benign goitres is multifactorial, involving potential haemorrhage, infection, or exacerbation of comorbid respiratory conditions. Early diagnosis through imaging and prompt intervention with thyroidectomy is crucial for survival. Postoperative monitoring for complications like laryngeal oedema and tracheomalacia is essential. This case emphasizes the need for vigilance in managing airway compromise in patients with large multinodular goitres.