Needle Aspiration for Severe Tracheal Compression Due to a Large Thyroid Goiter: A Case Report

A thyroid mass is an uncommon cause of a difficult airway when planning for intubation. An enlarged thyroid may lead to difficulties with intubation and airway management, oftentimes causing tracheal compression, deviation, or both. Tracheal compression increases the risk of tracheomalacia, which could lead to possible airway collapse. Moreover, the inability to intubate on the first attempt may increase the risk of airway-related complications to the patients. Here, we present three cases of a thyroid mass with a cystic component causing tracheal deviation or compression causing shortness of breath and difficult intubation which necessitated preoperative intervention. Various techniques such as inhalational anesthetic agents, fiberoptic intubation, and awake direct laryngoscopy-aided intubation have been described in the literature but were not used due to potential complications. Needle aspiration of the thyroid cyst was performed in each case to release pressure on the trachea before intubation. No complications occurred during or following the needle aspiration procedures. Each of the three patients was subsequently intubated with a glide scope and underwent a hemithyroidectomy for definitive management.