Delayed Presentation of a Massive Multinodular Goitre With Retrosternal Extension and Airway Compression in an...

Multinodular goitre is common, yet its potential for life-threatening airway compromise is often overlooked, particularly in euthyroid patients without overt thyroid dysfunction. Structural mass effects, rather than malignancy or hormonal imbalance, can lead to progressive tracheal narrowing and respiratory compromise, warranting early recognition and intervention. A 51-year-old woman presented with a 5-year history of a painless, enlarging anterior neck mass and 5 months of progressive dysphagia and exertional dyspnoea, without thyrotoxic or hypothyroid symptoms. Examination revealed a large multinodular goitre with tracheal deviation, retrosternal extension, and a positive Pemberton's sign. Imaging confirmed massive bilateral enlargement with significant tracheal narrowing. Thyroid function tests were normal; fine-needle aspiration was haemorrhagic and nondiagnostic. Total thyroidectomy was performed because of airway risk, and histology confirmed benign follicular nodular disease. Physicians must recognise that a euthyroid patient with a chronic goitre may present with acute or impending airway obstruction. Pemberton's sign, dysphagia, and exertional dyspnoea are red flags for significant tracheal compression, even when thyroid function tests are normal. Delayed referral risks catastrophic respiratory failure, particularly in resource-limited settings where surgical access may be limited. This case underscores that structural risk, not just malignancy, should prompt timely surgical evaluation.