Massive retropharyngeal goiter: Case presentation and literature review of a rare entity

Retropharyngeal goiters are uncommon entities characterized by the presence of thyroid tissue in the retropharyngeal space. We present the case of an 89-year-old female with a history of dysphagia and hoarseness of voice. Imaging revealed a massive goiter extending into the retropharyngeal and retrosternal spaces. The patient underwent a total thyroidectomy with transcervical removal of the substernal component. Our analysis of 13 documented cases (14 including ours) of retropharyngeal multinodular goiters reveals a range of presentations with dysphagia, dysphonia, and dyspnea being the most common symptoms. Total thyroidectomy emerged as the prevailing management approach, though there are surgical challenges including airway management and potential pharyngeal musculature injury. The most plausible mechanism for retropharyngeal goiter development is progressive displacement due to glandular enlargement. This case highlights the clinical considerations and perioperative strategies required for the management of retropharyngeal goiters, particularly in elderly patients with significant anatomic distortion. Additionally, we provide a comparative literature review to further characterize the presentation and surgical management of this rare entity.