Massive multinodular goiter causing airway compression: A case series

Area of Science:

• Endocrinology
• Surgical Oncology
• Anesthesiology

Background:

• Severe multinodular goiter (MNG) with extreme thyromegaly presents a life-threatening risk due to airway and vascular compression.
• This rare condition necessitates a specialized, multidisciplinary approach to mitigate severe perioperative complications.

Purpose of the Study:

• To outline a structured management protocol for patients with severe, airway-compromising MNG.
• To demonstrate the safety and efficacy of a standardized approach in a high-risk population.

Main Methods:

• A predefined protocol was applied to three consecutive patients with severe MNG, characterized by Pemberton's sign and >70% tracheal narrowing.
• Management included preoperative optimization, advanced imaging (CT), awake fiberoptic intubation, total thyroidectomy with intraoperative neuromonitoring, and ICU surveillance.

Main Results:

• All three patients underwent successful total thyroidectomy despite difficult airways and tracheomalacia.
• Postoperative follow-up of at least 3 months showed complete resolution of presenting symptoms.
• Histopathology confirmed benign MNG in all cases.

Conclusions:

• Severe MNG compromising the airway can be managed successfully through a meticulous, team-based strategy.
• Pemberton's sign and significant tracheal narrowing (>70%) warrant urgent surgical referral.
• The outlined principles offer a practical framework for managing this high-risk group, especially in resource-limited settings.